These guidelines are made possible by the generous support of the American
people through the United States Agency for International Development
(USAID). The contents are the responsibility of Adeso and do not necessarily
reflect the views of USAID or the United States Government
Acknowledgements
Adeso and the author thank all those contacted and spoken to during the course of this
study. In particular, thanks are due to the following people for their time and extremely
important contributions to the development of these guidelines and/or for reviewing and
commenting on the drafts of these guidelines and practical tools:
Paul Agunda (International Rescue Committee), Sarah Bailey (Overseas Development
Institute) Haley Bowcock (CaLP), Olivia Collins (Somalia Cash Consortium), Davide Coltri
(Save the Children), Sophie Dunn (Consultant), Sandra Durzo (IFRC), Alice Fay (Save the
Children), Kate Ferguson (IFRC), Martijn Goddeeris (Shelter Consultant), Professor Simon
Gregson (Imperial College London), Emily Henderson (Oxfam), Glenn Hughson (CaLP),
Marie LeDuc (Handicap International), Hanna Mattinen (UNHCR), Amanda McClelland
(IFRC), Sara McHattie (ECHO), Lili Mohiddin (CaLP), Sam Ombeki (CARE), Isabelle Pelly (Save
the Children), Lois Rabbit (CaLP), Laura Robertson (Imperial College London), Jessica Saulle
(Save the Children), Morten Skovdal (Save the Children), Dr. Marla Stone (MMM Learning and
Development), Sharon Truelove (Consultant), Anna Yalouris (MIT), Jake Zarins (Norwegian
Refugee Council) and all participants at the Nairobi Workshop.
The author is indebted to all contributors for their assistance and input, without which these
guidelines would not have been possible. However, all errors and omissions remain the
responsibility of the author.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Acronyms
ARV
Antiretroviral Therapy
CaLP
Cash Learning Partnership
CCT
Conditional Cash Transfer
CTP
Cash Transfer Programming
CfW
Cash for Work
FGD
Focus Group Discussions
FSL
Food Security and Livelihoods
ICT
Information and Communications Technology
IDPs Internally Displaced Persons
MFI
Micro Finance Institution
MoU
Memorandum of Understanding
NFIs
Non-Food Items
NGOs
Non Governmental Organizations
OVC
Orphans and Vulnerable Children
PDM
Post Distribution Monitoring
SOPs
Standard Operating Procedures
UCT
Unconditional Cash Transfer
WASH
Water, Sanitation and Hygiene
Adeso Sector-based Guidelines for Cash Transfer Programming
3
Contents
1. INTRODUCTION
6
2. ADOPTING A MULTI-SECTORAL APPROACH
8
3. ASSESSMENT AND ACCOUNTABILITY
12
4. EDUCATION
15
Why Give Cash and Voucher Incentives for Education ?
16
How Can Cash and Vouchers Be Used to Promote Education?
17
Assessing Appropriateness
27
Potential Issues
31
Setting the Payment Rate
33
Targeting34
Complementary Programs
35
Monitoring and Evaluation
35
Designing a CCT with Educational Objectives: Practical Tips
37
5. HEALTH
39
Why Give Cash and Voucher Incentives for Health ?
39
How Can Cash and Vouchers Be Used to Promote Health?
41
Assessing Appropriateness
46
Potential Issues
50
Supply-side Interventions
51
Targeting52
Setting the Payment Rate
53
Complementary Programs
55
Monitoring and Evaluation
55
Designing a CCT with Health Objectives: Practical Tips
57
4
Adeso Sector-based Guidelines for Cash Transfer Programming
6. SHELTER
59
Overview of Cash and Vouchers for Shelter
60
Why Give Cash and Voucher Incentives for Shelter ?
60
How Can Cash and Vouchers Be Used to Meet Shelter Needs?
61
Assessing Appropriateness
65
Project Design and Implementation
66
Technical Support for Construction
71
Setting the Payment Rate
74
Process for CTP for Shelter Repair or Rebuilding After a Natural Disaster
76
Monitoring and Evaluation
79
Further Reading
79
7. REFUGEES AND DISPLACED POPULATIONS
81
Overview of Cash and Vouchers for Refugee and Displacement Situations
81
Why Give Cash and Vouchers In Refugee and Displacement Situations?
81
How Can Cash and Vouchers Be Used in Refugee and Displacement Situations?
82
Assessing Appropriateness
88
Program Design and Implementation
89
Setting the Payment Rate
95
Monitoring and Evaluation
96
Further Reading
97
Adeso Sector-based Guidelines for Cash Transfer Programming
5
Introduction
There is a growing recognition of cash transfers as appropriate and effective tools to support
affected populations in emergency and early recovery situations in a way that maintains
dignity and choice while stimulating local economies. The use of cash, with an initial focus
on food security and livelihoods, has shown emerging potential and seen success in other
non - food security related sectors, such as shelter, health, education and displacement
situations.
In the past, humanitarian agencies have collaborated in the development of guidelines
to improve the design and modalities of cash and voucher based programs and the
identification and dissemination of best practice. However, previous guidelines have largely
focused on the food security and livelihoods (FSL) sectors. It is against this background
that Adeso, with funding from the United States Agency for International Development
(USAID), commissioned the development of sector based guidelines and practical tools for
the Health, Education, Shelter and Displacement sectors, to complement existing technical
manuals on cash-based responses.
These guidelines seek to respond to the need for guiding principles that adopt a broader
approach which reflects the increasingly multi-sectoral uses of cash and voucher based
programming in early humanitarian responses and recovery situations.
Whilst these guidelines are primarily aimed at assisting humanitarian organisations in their
responses to sudden or slow-onset emergencies and early recovery situations, they also
include learning points relevant to other phases, such as developmental situations, where
they can inform the design and implementation of humanitarian and recovery programs.
Developing these guidelines involved a desk based review of available knowledge,
experience and learning regarding cash transfer mechanisms in non-Food Security and
Livelihoods (FSL) sectors. In addition, discussions were held with key actors implementing
cash transfers within the chosen sectors. A one-day workshop was then held in Nairobi,
Kenya in February 2013 to which a range of implementing agencies were invited, in order to
obtain their input into the development of these guidelines. Initial drafts of the document
were then circulated to leading practitioners within these sectors for comment and review
before finalization of the content.
6
Adeso Sector-based Guidelines for Cash Transfer Programming
This document and the Practical Tools developed as part of the current research build on
the “Practical Guide to Cash-Based Responses” previously produced by Adeso. The three
documents are complementary, and should be used collectively as a source of practical
guidance for those implementing cash and voucher programs across these sectors.
Adeso Cash and Voucher Guidelines
1.
A Practical Guide to Cash-Based Responses.
2.
A Practical Guide to Cash-Based Responses: Sector Based Guidelines for Health,
Education, Shelter, Displacement and Refugee Situations.
3.
Sector-Based Practical Tools for CTP. These are available for the following sectors:
Health, Education, Shelter, Displacement and Refugee Situations.
Adeso Sector-based Guidelines for Cash Transfer Programming
7
Adopting a Multi-Sectoral Approach
Although these guidelines address the use of cash-based programming separately for
each of the key sectors, it is important to recognize that there are important and strong
interactions between sectors. Sectors are thus not independent, as actions targeting one
sector are likely to have ‘spill-over’ effects within other sectors. It is essential to consider
these interactions in program design, and to construct a ‘package’ of measures which
addresses the diversity of needs across sectors, taking into account any likely ‘spill-over’
effects between sectors.
Assessment processes should consider all household needs, and not be constrained to
considering only one sector. The subsequent response analysis needs to ensure that the
proposed intervention is appropriate to the household and community needs identified.
In addition, the continued appropriateness of the selected approach should be constantly
assessed throughout implementation through explicit inclusion of appropriate indicators
within the monitoring framework.
In deciding on the appropriate program response, it is also important to recognize that
aid agencies, donors and governments often have multiple objectives. In many cases
where there is a strategy for furthering the achievement of Millennium Development Goals
(MDGs), this includes measures to tackle poverty, hunger and improve human development
outcomes. In order to achieve this mix of objectives, a combination of Conditional Cash
Transfers (CCTs), Unconditional Cash Transfers (UCTs) and in-kind provision may be
appropriate. Vouchers are not usually suited to achieving multiple objectives, but may be
appropriate for addressing specific objectives.
Many of the case study examples in this report jointly target health and education outcomes
with the aim of promoting human capital development. For example, many Conditional
Cash Transfer (CCT) programs provide cash transfers to poor families which are subject
to compliance with educational and health requirements, typically school attendance
and regular medical check-ups. The overall aim is to build human capital and to break
the intergenerational cycle of poverty. By 2010, all but two countries in Latin America and
over 15 countries in Asia and Africa included a CCT program within their social protection
policies. In Latin America alone, there are over 110 million beneficiaries of such CCT
programs. This type of approach recognizes the cross-sectoral interactions between the
health and education sectors.
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Adeso Sector-based Guidelines for Cash Transfer Programming
This type of approach recognises the cross-sectoral interactions which are involved
between the health and education sectors.
Some examples of sectoral interactions include:
Public health and poverty alleviation interventions may lead to improved nutrition.
Nutrition outcomes impajct on education e.g. through early cognitive development, ability
to concentrate in school etc.
Improved education increases livelihood potential.
Improved livelihoods and shelter conditions are interconnected, with livelihood
improvements leading to improved shelter conditions which in turn can facilitate livelihood
development through both improved living conditions and increased access to borrowing.
Shelter and sanitation conditions are also closely linked, and improved access to water and
sanitation further impacts on health status, which improves ability of adults to engage in
work, and children to engage in education.
Adeso Sector-based Guidelines for Cash Transfer Programming
9
The following diagram illustrates some of these inter-sectoral interactions.
Increased
Household
Income
Improved
Food Security
Shelter Needs
Adequately
Met
Improved
Livelihood
Potential
Improved
Nutrition
WASH
Needs Met
Improved
Educational
Outcomes
Improved
Cognitive
Development
Improved
Health
Child Care
Rises in Next
Generation
Poor health is common among children in low-income countries, and is often made worse
by limited access to health care due to either low availability of health services or low
ability of the poor to access these services. Poor child health is linked to poor growth and
cognitive development, with potential long-term consequences. Poor health can lead to
children being less likely to enroll in school, or enter school late, and when they do enroll
they are likely to perform worse than healthy children. This demonstrates the need for a
multi-sectoral approach when considering how best to use cash transfers to address issues
of improving health and education outcomes amongst the poor.
In addition, education of women has significant benefits for the health of their future
children. There is evidence from Africa that children of mothers who have completed five
years of primary education are 40% more likely to live beyond the age of five.
The above examples illustrate the importance of recognizing linkages between sectors, and
taking a comprehensive view of issues and needs across all sectors when deciding on the
most appropriate form of intervention.
10
Adeso Sector-based Guidelines for Cash Transfer Programming
The existence of strong multi-sectoral interactions also highlights the need for close
coordination between:
Different departments and sectoral teams within the organization.
Different organizations, agencies and stakeholders working across the sectors.
Emergency response/humanitarian actors and development agencies.
This coordination should occur at all stages of the intervention, from emergency
preparedness and needs assessment through to program design and implementation, and
onwards.
Adeso Sector-based Guidelines for Cash Transfer Programming
11
Assessment and Accountability
In developing cash-based interventions, it is essential to have transparency and accountability
to target populations as well as donors, government agencies and other stakeholders. A key
aspect of accountability to target populations is ensuring that the response analysis is based
on a rigorous assessment of the situation. This should include the origins and likely duration
of the crisis, local economic context (including market conditions), the national and local
legislative/policy environment and - central to the analysis - the needs and preferences of
the target populations.
These guidelines consistently draw attention to the fact that cash-based programming is
a tool for use in achieving program objectives and meeting beneficiary needs - it is not an
objective in itself. In addition, it is important to remember that cash and in-kind responses
are not mutually exclusive - the appropriate response may be a combination of cash and
in-kind interventions.
An essential pre-requisite for deciding whether or not a cash-based program or another
form of intervention is most appropriate is a process of engagement with affected
populations and other key stakeholders. This will ascertain the nature of beneficiary needs
and preferences and, based on this assessment, identify the most appropriate form of
intervention. This may indicate that cash transfers are appropriate, or that it would be better
to adopt a different approach, such as in-kind aid, education and information campaigns, or
other forms of assistance.
All interventions, whether cash-based or otherwise, should ensure accountability to
beneficiaries and other stakeholders though compliance with key humanitarian standards.
In particular, the following standards should be considered during program design,
implementation and evaluation:
The Sphere Project provides a set of minimum standards for humanitarian sectors
which are outlined in the four technical chapters of the Sphere Handbook: water supply,
sanitation and hygiene promotion; food security and nutrition; shelter, settlement
and non-food items; and health action. There are also core standards that apply to
all technical sectors. The minimum standards outline best practice in humanitarian
response and describe the conditions to be met in any humanitarian response in
order to support disaster-affected populations in surviving and recovering in stable
conditions and with dignity. Sphere 2011 standards for humanitarian interventions are
available at: http://www.spherehandbook.org.
12
Adeso Sector-based Guidelines for Cash Transfer Programming
Development Assistance Committee (DAC) Guidance for Evaluating Humanitarian
Assistance in Complex Emergencies is based on the premise that the purpose of
evaluation is “to determine the relevance and fulfillment of objectives, developmental
efficiency, effectiveness, impact and sustainability” of efforts supported by aid agencies.
The five criteria underpinning DAC evaluations are thus: (1) relevance, (2) effectiveness,
(3) efficiency, (4) impact and (5) sustainability. Under DAC criteria, evaluation should
be part of the planning process from the start - clear objectives are essential for an
objective evaluation. Guidance on using the DAC criteria is available at: http://www.
alnap.org/resources/guides/evaluation/ehadac.aspx.
The SEEP (Small Enterprise Education and Promotion) Network’s Minimum Economic
Recovery Standards provide minimum industry standards for facilitating economic
recovery in crisis situations and seek to improve accountability of humanitarian
practitioners. The SEEP handbook provides guidance to interventions to improve
income, cash flow, asset management and growth among crisis-affected households
and enterprises. It emphasizes the importance of encouraging the re-start of enterprises
and livelihoods strategies and improving market productivity and governance. SEEP
Minimum Economic Recovery standards are available at: http://www.sphereproject.
org/handbook/handbook-companions/the-seep-handbook/.
Care should be taken in the use of incentives (cash or in-kind) to encourage attendance at
training sessions and community meetings (such as health, nutrition or WASH education
and awareness sessions). Incentives can create dependency or future expectations of
‘entitlement’ to payments, and their regular or prolonged use can cause reluctance to
participate in future events without some form of payment.
Unconditional Cash Transfers (UCTs)
By providing flexibility in choice, Unconditional Cash Transfers will tend to impact across
all sectors and can, in many circumstances, provide an appropriate tool for responding to
needs across multiple sectors. UCTs achieve cross-sectoral impacts by making expenditure
on a range of items - such as food, health, education and shelter - more affordable.
The poorest households must be able to reach a minimum threshold of food consumption
before they can consider making investments in human capital development such as health
or education expenditures. In light of this, an unconditional cash component can prove
appropriate in humanitarian programs aimed at sectors such as health, education or shelter.
Adeso Sector-based Guidelines for Cash Transfer Programming
13
For example, cash provided for shelter is likely to be diverted in order to meet basic survival
needs such as food needs, if households are not able to meet these needs in other ways.
By improving the nutritional status of households, UCTs can also contribute to improved
outcomes of health and education programs.
Conditional Cash Transfers (CCTs)
Imposing conditions incurs additional costs for beneficiaries and the implementing agency.
Consequently, they should only be applied if they significantly improve achievement of
program objectives. For conditions to be justified, they need to generate enough benefits
(for participants and/or society) to outweigh any extra costs. There should be a valid
justification for constraining a poor household’s use of cash resources to meet their needs.
The implications of conditionality should be carefully assessed during the program design
stage to ensure that they do not result in the exclusion of the most vulnerable groups.
The most vulnerable groups may also be those who find it hardest to comply with the
conditions.
When conditions are used, they should be structured as simply as possible to achieve the
intended result. Complex conditions increase costs and complexity of monitoring, and are
unlikely to be easily understood by beneficiaries, reducing the likelihood of compliance.
The design of conditions should be carefully considered to avoid unintended impacts. This
includes having appropriate exit strategies to avoid creating dependency.
In practice, CCTs may be preferred because they are seen as more politically acceptable the poor must “do something” in order to receive payments and are not “getting something
for nothing”. Conditions can also generate positive feelings associated with promoting
human development and economic growth. CCTs may therefore be favored by politicians
and agencies due to their acceptability to voters and funding agencies.
Vouchers
Vouchers can be for specific commodities, or for a fixed monetary value redeemable at
approved merchants or within an organized ‘fair’, to which merchants and beneficiaries are
invited. Using value vouchers allows families to decide which needs to prioritize, whereas
commodity vouchers can be used to ensure the beneficiaries receive specific goods which
further the programs objectives (e.g. hygiene goods or basic food items). Vouchers are
suitable when the main issue is the cost of a specific service or good, and there are no
additional costs involved. Vouchers are most easily used when there is a choice of suitable
merchants or service providers, and the services or products required are non-complex and
predictable.
14
Adeso Sector-based Guidelines for Cash Transfer Programming
Education
Photo Credit: Daniel Gerstle (© Adeso)
Adeso Sector-based Guidelines for Cash Transfer Programming
15
Education
Why Give Cash and Voucher Incentives for Education?
CCTs involving educational conditions originated in South America, with government
programs in Brazil (Bolsa Escola) and Mexico (Progresa, now Oportunidades). The success
of these schemes has led to their widespread replication across South America, and more
recently in Africa and Asia.
Emergency programs focus mainly on meeting basic survival needs. Consequently, cash
transfer programs specifically targeting education are mostly found in developmental and
recovery contexts. In addition, during an emergency other needs such as shelter, WASH,
and food/nutrition can become even more important considerations affecting access to
quality education. In an acute emergency, cash transfers are therefore frequently provided
in the form of unconditional grants aimed at meeting a diverse range of immediate needs,
of which expenditure on education is often one element which recipients may choose to
target. This kind of cross-sectoral approach for addressing multiple needs can help reduce
educational drop-out resulting from competing priorities.
Both conditional and unconditional transfers have been shown to improve school
enrolments and attendance. Increased income enables households to pay fees or other
costs associated with attending school. It also reduces pressures on children to contribute
to family income, enabling them to attend school. Where cash transfers lead to improved
nutrition, children may subsequently perform better in school. Less evidence has been
collected on whether cash transfers improve educational outcomes (e.g. grade pass rates);
this will depend on the quality of education services available.
Cash transfers can boost demand for education by reducing the barriers that restrict access
for poor or vulnerable groups e.g. by making education more affordable. Many of the world’s
poorest people cannot effectively access education services, even when such services
are ‘free’ at the point of delivery. The costs that the chronically poor face in using these
services can include the loss of children’s earned income and direct costs such as travel,
school materials, and uniforms. Discrimination against girls, children with disabilities, and
children affected by AIDS can exacerbate the difficulties caused by these financial barriers.
The poorest fifth of children in low income countries are less likely to start school and more
likely to drop out.
Caregivers may not always act in the best long-term interests of their children. Agencies
might provide incentives for carers to invest more in education because they believe:
16
Adeso Sector-based Guidelines for Cash Transfer Programming
Carers may lack sufficient information to make the best long-term
decision for their children.
Carers’ interests may differ from those of the child, leading them to prioritize shortterm gains from children’s labor over the long-term benefits the child would gain from
education.
Even when caregivers are acting in their children’s best interests, greater investments in
education may provide important benefits for society and the economy as a whole.
Potential benefits from using cash and voucher programs to promote education include:
More equitable access to education for poor and disadvantaged groups.
Increased levels of attendance and enrolment.
Increased awareness among communities of the importance of education
Reductions in child participation in paid labor.
How Can Cash and Vouchers Be Used to Promote Education?
By improving household incomes, cash transfers (conditional or unconditional) mean that
households are better able to afford the costs of educating their children. For the chronically
poor, a regular increase in their income can increase the likelihood of them investing in
education. By linking the transfers to compliance with conditions, the schemes can highlight
the importance of education and signal its value. In addition, information campaigns can be
linked to these programs to inform participants of the value of educating their children and
its benefits in helping to overcome poverty.
Unconditional Cash Transfers
Unconditional Cash Transfers can increase uptake of education services by increasing
the household’s overall income, making expenditure on education more affordable.
Consequently, cash transfers have been shown to impact children’s education even when
they are not conditional on the use of educational services. In Kalomo, Zambia, absenteeism
declined by 16% over the first nine months of an unconditional cash transfer scheme
targeting vulnerable households; often grandparents caring for AIDS-affected children.
In Brazil, Namibia and South Africa , the provision of old age pensions without education
conditions also significantly increased education of children, particularly girls. Properly
designed and implemented cash transfer programs – both conditional and unconditional –
tend to improve school enrolment and attendance.
Adeso Sector-based Guidelines for Cash Transfer Programming
17
A further reason for including an unconditional cash component in education programs
is that the poorest households need to be able to reach a minimum threshold of food
consumption before they are able to consider investing in education expenditures. In
addition, improved nutritional status can increase children’s ability to benefit from the
education provided.
By tackling poverty and hunger, Unconditional Cash Transfers can also help to address
some of the underlying causes of inequalities in access to education and educational
attainment. For example, improving nutrition of very young children is important for
cognitive development and improves their ability to benefit from education once they
reach school age. A comprehensive approach taking a long-term view may thus begin with
unconditional transfers to aid early childhood development, rather than solely focusing on
school age children.
Agencies should consider whether providing an Unconditional Cash Transfer, accompanied
by a fee waiver (i.e. exemption from school fees), could be sufficient to achieve the desired
improvement in enrolment, without incurring the higher monitoring costs associated with
conditional transfers.
Unconditional Cash Transfers may also be an appropriate response where service coverage
is poor and compliance difficult. Unconditional transfers should at least improve children’s
nutrition and physical and cognitive development, leading to better health. This can lead
to healthier and more cognitively developed children, who will be better able to take
advantage of educational opportunities in the future should service provision improve.
18
Adeso Sector-based Guidelines for Cash Transfer Programming
Examples of Using Cash and/or Vouchers in the Education Sector
Indirect
Interventions
Interventions Directly Targeting Beneficiaries
Promoting and Supporting
Directly providing pre-
Interventions improving
access to services by
defined goods or services
access to education through
children and their families
through cash or vouchers.
targeting other points in the
through provision of cash
supply chain.
or vouchers.
UCT to increase affordability Cash and/or vouchers for:
CfW to construct or repair
of educational services and
school facilities.
materials.
CCT for teachers’ incentives
CCT incentives for:
Attendance at school.
School fees
School enrollment.
School supplies/
Completion of
uniforms
to improve teacher skills
or
quality
of
education
provided.
educational objectives
Sanitary items for girls
UCT
(e.g. graduation).
Transport costs
nutrition to aid cognitive
for
early
child
development.
Conditional Cash Transfers (CCTs)
Conditional Cash Transfers assume that linking payments to compliance with conditions
creates additional incentives for fulfilling program objectives. CCTs require beneficiary
households to fulfill certain criteria in order to participate in the program. Failure to comply with
the conditions may reduce beneficiary entitlements, or result in exclusion from the program.
Due to problems in monitoring compliance in emergency settings, CCTs for education are
mostly used in recovery or development contexts.
Types of conditions which beneficiaries may be required to comply with include:
Enrolling (or re-enrolling) one or all of their children in school. It is important to be aware
that enrolment does not always translate into attendance.
Minimum attendance at school per month by children entered into the program.
Educational achievement, such as passing grades, graduation, or enrolment at a higher
level education establishment. Conversely, program rules may allow children to fail each
grade once, but then remove benefits permanently if a student repeats a grade more than
once.
Children not engaging in paid work.
Adeso Sector-based Guidelines for Cash Transfer Programming
19
Education Case Study 1:
CCT Impacts on Educational Outcomes in Developing Countries
The following findings were identified by Saavedra and Garcia (2012) based on a review of
42 evaluations of educational Conditional Cash Transfer programs across 15 developing
countries.
Key Findings
CCTs reduced dropout rates by twice as much in secondary school as primary schooling.
Effects on attendance are greater where baseline (starting) attendance levels are lower.
Greater cash transfer amounts are significantly associated with greater primary and
secondary enrolment effects (and in some cases with increased secondary school
attendance), suggesting that larger transfers may better compensate for the opportunity
cost of sending children to school.
At both primary and secondary levels and for both enrollment and attendance
outcomes, the frequency of payment was negatively associated with the size of effects.
Programs in which payments were bi-monthly or quarterly reported greater effects
than those with monthly payments.
Imposing conditions on achievement (e.g. not failing grades) beyond the standard
attendance conditions is positively associated with greater secondary enrolment and
attendance effects.
There were significantly greater primary enrolment effects in programs that also
sought to expand supply through grants, infrastructure or other resources for schools.
Results were consistent with impacts being greater in areas with better school
infrastructure and pupil-teacher ratios.
Effects on secondary enrolment and attendance are greater for CCT programs in Asia
or Africa than for those in Latin America.
CCTs were more effective where initial enrolment and attendance levels were relatively
poor and for that reason, particularly effective in improving secondary schooling
outcomes.
For primary school students, offering a larger transfer amount and coupling transfers
with additional resources to support infrastructure, textbooks or teachers is associated
with greater program effects.
The relative effectiveness of CCTs for secondary schooling outcomes and additional
costs related to transfer generosity and supply-side resources suggest that under tight
20
Adeso Sector-based Guidelines for Cash Transfer Programming
budgetary conditions, targeting secondary level pupils with CCT investments is one
way to improve cost effectiveness.
Conclusions:
Impacts of CCTs on primary and secondary schooling were positive and statistically
significant.
Impacts on secondary enrollment, attendance and dropout are greater than those for
primary.
Programs that place conditions on school achievement (e.g. not failing grades) and pay
transfers less frequently are more effective than those which only apply attendance
conditions.
Programs with more generous transfers have greater primary and secondary enrollment
effects.
Programs that include conditions related to achievement and pay transfers less
frequently than monthly exhibit greater enrollment and attendance effects.
Source: J. E. Saavedra and S. Garcia Impacts of Conditional Cash Transfer Programs on
Educational Outcomes in Developing Countries. RAND Labor and Population Working
Paper WR-921-1 Feb. 2012
Securing an extra year’s attendance at school may not translate into a better level of
educational achievement (test scores) if:
a)
The quality of education provided is very poor.
b)
Current school capacity is unable to adequately meet the extra demand, resulting in
the quality of education provided declining as attendance rates increase.
c)
Other factors prevent the child from being able to learn well (e.g. hunger, domestic
pressures, bullying/stigmatization/discrimination from teachers or other students).
Making cash transfers conditional on exam performance can help to increase pass rates
amongst beneficiaries. This was shown in the Female Secondary School Assistance Program
in Bangladesh, where program beneficiaries had higher pass rates than the national average
for girls.
There must be a valid justification for constraining a poor household’s use of cash resources
to meet their needs. For educational conditions, generally one of three arguments must
hold:
Adeso Sector-based Guidelines for Cash Transfer Programming
21
(1) The parents do not have sufficient information to make the best decisions about their
children’s education.
(2) There is reason to believe that parents will not act in the best long-term interests of
their children.
(3) The aim is to compensate households for investments in education which benefit
society as a whole, rather than just directly benefitting the household.
When any of these three effects is significant, it may be appropriate to impose conditions.
The design of conditions should be carefully considered to avoid unintended impacts. This
includes having appropriate exit strategies. Without appropriate “exit” options, Conditional
Cash Transfers might induce students to unnecessarily repeat their final year of secondary
school, solely in order to continue to qualify for the cash grant . In addition, the private costs
to households (including financial costs, time, and effort involved in complying) should be
considered when evaluating the appropriateness of applying conditions.
Because imposing conditions incurs additional costs for beneficiaries and the implementing
agency, they should only be applied if they significantly improve achievement of program
objectives. For conditions to be justified, they need to generate enough benefits (for
participants or society) to outweigh any extra costs.
The key questions in deciding whether to impose conditions on the cash transfer are:
Could the same impact be achieved through unconditional transfers and/or
improvements in the quality and quantity of education services provided?
Does the extent of any additional gains from conditions outweigh the additional
costs incurred by beneficiaries (e.g. financial, time and effort) and the agency (e.g.
monitoring)?
Vouchers
Vouchers can be for specific commodities or for a fixed monetary value redeemable at
approved merchants or within an organized ‘fair’, to which merchants and beneficiaries are
invited. Using value vouchers allows families to decide which needs to prioritize. In the
Democratic Republic of Congo (DRC), school representatives have been invited to attend
‘voucher fairs’ to enable beneficiaries to use the vouchers to pay school fees. Goods and
services that may be provided using vouchers or restricted cash grants include:
22
School fees.
School supplies, including school uniforms, enabling families to choose appropriate
Adeso Sector-based Guidelines for Cash Transfer Programming
sizes.
If the cost of transport to and from school is a barrier to accessing education, children
could be given vouchers redeemable on the bus or other transport.
Sanitary supplies for adolescent girls. Provision of sanitary items can reduce absenteeism.
Vouchers are suitable when the main issue is the cost involved in paying for a specific service
or good, and there are no additional costs involved. Vouchers are most easily used when
there is a choice of suitable merchants or service providers, and the services or products
required are non-complex and predictable e.g. vouchers for textbooks. Education Case Study 2:
Education Support through Voucher Fairs During Emergency Assistance to Newly
Displaced and Host Families in North Kivu, DRC
In 2008, an escalated fighting between rebels and the Congolese Armed Forces led to
widespread displacement of populations in North Kivu, Democratic Republic of Congo
(DRC). In response, Concern Worldwide implemented a nine month emergency project
to increase access to food, non-food items and water for displaced and host families. The
project used ‘voucher fairs’ to enable families to purchase non-food items and pay school
fees.
The voucher fairs involved the following elements:
Beneficiaries received $35 worth of vouchers, plus two blankets and soap.
Traders were pre-selected from intervention areas in order to contribute to the local
economy.
Articles were pre-selected based on focus group discussions (FGDs).
Prices of articles were fixed based on market research and negotiations with traders.
Primary school fees could be paid to headmasters at the fairs.
Key Findings
The option of paying school fees was an especially popular aspect of the intervention. Onefifth of beneficiaries used vouchers to pay school fees and 27% of those beneficiaries paid
for more than one child or trimester. For parents with children in primary school, school
fees were an expenditure priority that they were struggling to meet because fighting and
displacement had interrupted livelihoods. Payment of school fees enabled children to
Adeso Sector-based Guidelines for Cash Transfer Programming
23
continue their studies, as they are often sent home from school if fees are not paid. The
inclusion of school fees tipped many recipients towards a preference for fairs over in-kind
assistance. The majority preferred the fairs to receiving pre-packaged NFI kits, cash or
vouchers to use in the local markets because the fairs enabled them to pay school fees,
provided them with choice and were safer than receiving cash or vouchers to use in the
local market.
Humanitarian agencies should consider inclusion of school fees in the voucher fairs.
Key Issues
The lack of small voucher denominations meant beneficiaries could not pay for
articles with precise amounts and traders did not provide change in the form of cash
or vouchers.
High prices at fairs were the main complaint of beneficiaries. Prices were higher than
‘normal’ market prices due to three factors: (1) different quality of items compared to
those in the local market; (2) traders did not always provide change; and (3) despite
efforts to set prices at or below market level, prices were not accurate for all items.
Taking measures to ensure lower prices in fairs would increase efficiency and
effectiveness. Concern would make funds stretch further, and recipients would meet
more of their needs.
Using vouchers required more planning and was slightly more expensive compared with inkind distributions, but had the benefit of providing more choice to recipients and supporting
local traders. The fairs were marginally more expensive due to loss of savings from bulk
purchasing through competitive tendering. However, working with local traders directed
profits to local businesses as opposed to ones outside of the intervention area.
Source: Sarah Bailey, 2009. An independent evaluation of Concern Worldwide’s emergency
response in North Kivu, Democratic Republic of Congo. Responding to displacement with
vouchers and fairs. Humanitarian Policy Group Overseas Development Institute, London
Cash for Work
Cash for Work can also be referred to as a conditional cash transfer, and can be used to help
construct school facilities such as classrooms. This should usually involve cooperation/
partnership with relevant government/educational authorities. Ensure that any construction
or building work is not being carried out by children. Also ensure that construction sites
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Adeso Sector-based Guidelines for Cash Transfer Programming
which could pose a danger to children (e.g. deep holes) are adequately fenced off to ensure
children are not put at risk.
Don’t Forget the Supply-side
Cash transfers can be used to increase the use of existing educational resources. However,
failure to improve the supply of education capacity can disadvantage children already in
schools by reducing the quality of provision. Relatively small cash transfers will not easily
overcome transportation barriers for long distances, and supply-side responses such as
increased local provision of school facilities may be necessary. When assessing whether to
send their children to school in response to a CCT program, parents take into account the
quality of local schools. Consequently, they are more likely to enroll their children in school
if the quality of education provided is high.
Ensuring appropriate quality of education provision must be considered if beneficiaries are
to enjoy the potential gains from increased school enrolment and attendance. In many
developing countries there may not be enough schools, classrooms or teachers to meet
the increased demand for education by participants trying to satisfy conditions. Before
implementing a program, it is essential to assess the availability of and need for necessary
infrastructure (schools, transport etc.), and to identify whether the lack of demand is due to
remoteness from schools or low quality of schooling that provides no meaningful returns
for attendance.
Supply-side Interventions Which May Be Considered Where Supply Is
Inadequate Include:
Capacity development of teachers and pupils through life skills training and, where
appropriate, wages or bonuses for teachers.
Payments of bonuses to schools for each child participating in the program to cover
school materials etc. In Nicaragua’s Red de Protección Social, teachers receive a small
bonus per child participating in the program, half of which is intended to pay for school
materials.
In Honduras, supply-side measures to improve education provision included cash
grants which could be applied for by Parent Teachers Associations associated with a
given primary school.
Cash for Work programs to assist with construction or repair of school buildings, clear
school grounds, ensure a safe school environment etc.
Adeso Sector-based Guidelines for Cash Transfer Programming
25
It is important to carefully consider the demand and supply-sides when planning CCT
programs for education; something which has often been overlooked in past interventions.
Nicaragua’s CCT was not only more effective in supply-constrained areas but also improved
school supply as measured by grade availability, number of sessions per day and number
of teachers. To provide incentives to the teachers who had additional reporting duties and
larger classes, as well as to increase resources available to the schools, a small “supplyside” cash transfer, known as the “teacher transfer” was given to each beneficiary child,
who passed it to the teacher. It was precisely in those intervention areas with poor initial
school supply conditions, as measured by indicators of grade availability and distance to
school, that the program was most effective in improving school supply. This demonstrates
that initial school supply conditions need not represent an insurmountable obstacle to
implementing a CCT program, as long as supply constraints are identified at the planning
stage and mechanisms put in place to address them during the implementation stage.
Assessing Appropriateness
Preconditions for Using Cash and Vouchers for Education
Prior to implementing interventions with educational objectives, the reasons for nonparticipation in, or drop-out from education must have been investigated and identified
to correctly target the barrier(s) to inclusion. It is then possible to decide whether these
barriers can be best overcome though Unconditional Cash Transfers, Conditional Cash
Transfers, or in-kind interventions.
Most cash-based interventions with specific educational objectives have, to date, involved
some form of educational conditions which beneficiaries have to comply with in order
to receive the cash. However, the costs associated with imposing conditions mean that
they should only be used if they will significantly improve the achievement of program
outcomes, the expected benefits outweigh the costs involved and they do not result in the
exclusion of the most vulnerable groups (see also Chapter 3). Other preconditions before
CCTs can be considered include:
26
The educational service or good(s) that the Conditional Cash Transfer is conditioned
upon must be functioning, safe, accessible and have the capacity to include new
participants.
The administrative capacity and skills required for implementation must be available
at the required level e.g. capacity of teachers (or other responsible agent) to monitor
compliance.
Adeso Sector-based Guidelines for Cash Transfer Programming
Identifying Reasons for Low School Attendance
When designing any cash or voucher based intervention to promote education it is essential to
identify the specific reasons why poor households are not making sufficient use of educational
services.
Public education services may be inaccessible or of such low quality that the poor rationally
choose not to use them. Is the problem of low uptake of education due to a lack of demand by
households, or is it due to poor availability or quality of service provision?
If the problem is rooted in households’ undervaluing their children’s education due to lack of
information, an information campaign and the imposing of conditions may be appropriate. For
example, some communities may undervalue the benefits of girls’ education.
Discrimination and cultural insensitivity in the supply of public services can hinder their use.
If the problem results from poor quality or inaccessibility, the intended benefits of a CCT are
unlikely to be achieved unless accompanied by supply-side interventions. It is important not to
mistake problems with service supply for low demand. It may be perfectly rational for parents
not to send their children to school if the quality is poor and the benefits of attendance are
very low.
Adeso Sector-based Guidelines for Cash Transfer Programming
27
Why is School Attendance Low?
If the problem is low demand because of poor information, it is important to weigh the
costs and benefits of a direct information campaign against imposing conditions on cash
transfers.
High child labor rates and low school attendance rates may indicate that parents are failing
to act in the best long-term interests of their children, or that the household is so poor that
they cannot afford the loss of income from child labor required for children to attend school.
Unconditional Cash Transfers directly tackle poverty and may be sufficient to increase the
demand for education – particularly when combined with improved quality of schools and
a direct information campaign.
General Principles
The educational service or good that the project is seeking to promote uptake of must be
functioning, safe, easily accessible and have to have capacity to include new participants.
Gender equality should be a part of the overall design of educational programs.
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Adeso Sector-based Guidelines for Cash Transfer Programming
If all children in the household are not included in the program, consider impacts on
siblings of participant children.
Consider the needs of children with disabilities. If there are no disabled children,
establish whether they are being excluded from education.
Ensure that the most vulnerable children (e.g. OVCs, HIV-affected) are not excluded.
The impact of gender on access to education is often an important factor determining
household priorities for educating children, and should be a key consideration in program
design and monitoring.
For education, regularity of payments and timing of payments can be important factors
influencing outcomes (e.g. payments that coincide with school fees being due), and in
many cases will be as important as the actual level of payment in influencing behavior.
Identify which institutions and government departments need to cooperate with the
program in order to effectively implement cash transfers for education (e.g. social welfare,
education).
Will Conditions Improve Educational Outcomes?
Conditional transfers are most likely to be effective in increasing participation in education
in situations where participation rates are initially low, child labor is high (high opportunity
costs), or there is discrimination against girls or disabled children attending school. Where
main barriers to participation are direct costs, a scholarship (covering fees) may be sufficient,
possibly along with an Unconditional Cash Transfer or vouchers for directs costs (e.g.
uniform, books etc.).
If school enrolment rates are already very high, conditions related to school enrolment
will be unlikely to have a large impact. For example, in Mexico well over 90% of primary
school age children were enrolled, even in the absence of participation in the program.
Consequently, Mexico’s Oportunidades program had little effect on enrolment amongst
this age group.
The following table provides guidance on situations in which educational conditions are
likely to be most successful in improving educational outcomes, and when they are likely
to be least effective.
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29
Factors Affecting the Impact of Conditions on Educational Outcomes
Environmental
Factors likely to improve the
Factors likely to reduce impact of
Conditions
impact of conditions on program
conditions on program outcomes
outcomes
Current
If school attendance is initially If school attendance is already high
demand
low, there is greater scope for (e.g. 90%+), there is less scope for
for education
conditions to increase use.
(e.g. school
If child labor is high, conditions When unemployment rates are
attendance
may compensate for income lost high, child labor tends to be less
rates).
when children attend school.
conditions to increase their use.
in demand, reducing its impact on
educational attendance.
Level of
Systems present to deliver the If
provision of
required quantity and quality of cannot be provided adequately
education
education services.
infrastructure
quality
education
services
to meet the increased demand,
Although provision is inadequate, conditions will cost households
(schools,
the
quality
to improve provision prior to little benefit.
education).
imposing conditions.
Capacity for
Agencies have, or can easily
If administrative capacity is weak.
administration.
acquire, the administrative
Lack of capacity to accurately
capacity to implement the
monitor compliance.
will
and
resources
exist time and effort in complying, with
program and monitoring
conditions.
Ability of poor
Beneficiaries are easily able to If resources or circumstances
beneficiaries
access services required to respond inhibit beneficiaries from easily
to respond to
to the incentives created by cash responding to incentives. e.g.
conditions.
transfers e.g. schools are easily schools are far from beneficiaries,
accessible, and have capacity/ increasing compliance costs,
quality of provision.
effort involved etc.
Program
Good program design can increase Rigidly imposed conditions risk
Design.
compliance and impacts e.g. where excluding the most vulnerable,
f ailure to meet conditions triggers who find it hardest to comply.
intermediation
services
that Imposing
support households in complying.
support
penalties
for
without
compliance
can
exacerbate problems that led to
non-compliance.
Adapted from EPRI “Designing Conditional Cash Transfers” Chapter 9
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Adeso Sector-based Guidelines for Cash Transfer Programming
How Strictly Should Conditions be Enforced?
The most vulnerable members of the community may also be those who find it hardest to
comply with the conditions, possibly due to:
The costs involved (transport to school, costs of school materials etc.).
Lack of skills and abilities required for dealing with administrative procedures.
Competing demands of family circumstances, such as the child having to care for a
chronically ill household member, or a child head of household caring for siblings.
If conditions are too rigidly enforced, they may encourage parents to send ill children
to school or make other decisions that could have negative consequences for the child,
the household or the community. In addition, severity in applying penalties may deprive
households of resources vital to poverty reduction, and if this results in increased drop-out
rates from the program it may undermine educational outcomes. Care is therefore required
in responding to those who are unable to comply with conditions. For example, denying a
child the transfer because they missed school to attend to a sick family member is unlikely
to result in the best outcome for the child. Instead, it may be more appropriate to support
the child to enable them to meet the required conditions and attend school.
Under Brazil’s Bolsa Escola, failure to meet conditions triggers intermediation services that
provide additional support. Households are not penalized but rather supported in meeting
educational or health requirements, increasing the likelihood of compliance. A similar
approach was adopted in Manicaland, where those who failed to comply were assigned a
‘community volunteer’ to support them in meeting the conditions (see Case Study 4 in the
Health Section).
Potential Issues
Potential negative effects which should be considered in designing programs include:
Siblings of targeted children may be negatively affected (working in place of the
targeted child, families diverting resources away from children not in the program).
Families attempt to bribe or intimidate teachers to falsify attendance records.
Storekeepers try to influence or cheat beneficiaries unused to the voucher system.
Adeso Sector-based Guidelines for Cash Transfer Programming
31
Education Case Study 3:
Restructuring Conditional Cash Transfer programs to increase re-enrollment in
secondary school without weakening students’ attendance
In 2005, Bogotá established the Conditional Subsidies for School Attendance program to
increase student retention, lower drop-out rates and reduce child labor. Hoping to better
fulfill the goals of the program, while keeping the costs of the interventions roughly the
same, three variations of a CCT for education were tested:
(1) A basic payment for school attendance ($15 USD/month for 80%+ attendance).,
(2) aA basic payment for school attendance in which part of the transfer is delayed until
the student pays school fees for the next year, ($10 USD/month for 80%+ attendance,
$50 USD at next enrollment time).
(3) A basic payment for school attendance in which students received lower monthly
payments but were guaranteed a large payment upon graduation ($10 USD/month
for 80%+ attendance, plus $300 USD on enrolment in higher education, otherwise
delayed to one year after graduation from secondary).
Postponing part of the transfer to a larger payout when school fees for the following
year were due increased enrollment without reducing daily attendance. Students who
received a large sum of money right before they had to pay their annual school fees
were more likely to re-enroll than students who received regular transfers. This was
particularly true for the poorest and most at-risk students.
Participants were highly responsive to incentives for high school graduation and
enrollment in higher education. Students who received a large award upon graduation
were 49 percentage points more likely to enroll in a higher education institution.
The two modified programs were especially effective at improving enrollment of
the lowest-income students and the students with the lowest participation rates. In
comparison, the standard program did not differentially increase enrollment for the
poorest and most at-risk students.
Siblings, particularly sisters, of students in the program attended school less frequently
and dropped out more often than those in families with no children in the program.
Families with a child in the program appeared to re-allocate educational opportunities
away from their other children.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Key Results
Although the two non-traditional programs provided lower monthly payments for good
attendance, they were just as effective as the standard treatment in terms of attendance
levels achieved.
The non-traditional designs improved re-enrollment by more in the following year.
The savings approach was especially effective at improving the re-enrollment of the poorest
students and those most at-risk of drop-out.
The non-traditional designs increased enrollment in higher education institutions, while the
standard intervention did not.
Policy Lessons
Policymakers can target specific behaviors by adjusting the design of educational CCTs.
Incentivizing graduation rather than just attendance was particularly effective. Students
receiving graduation incentives attended school more often and were more likely to reenroll in secondary school and enroll in higher education.
Experimenting with the design of incentive programs can make them more effective, in
some cases without increasing program costs.
Source:
J-PAL Policy Briefcase. 2012. “Redesigning Conditional Cash Transfers.” Cambridge, MA:
Abdul Latif Jameel Poverty Action Lab.
Barrera-Osorio, Felipe, Marianne Bertrand, Leigh Linden, and Francisco Perez-Calle. 2011.
“Improving the Design of Conditional Transfer Programs: Evidence from a Randomized
Education Experiment in Colombia.” American Economic Journal: Applied Economics.
3(April): 167-95.
Setting the Payment Rate
Key questions in setting the payment rate are:
Are household members meeting their basic survival needs (e.g. food needs, shelter,
health)? If not, any money is likely to be diverted to addressing survival needs (e.g.
food). Programs need to ensure measures are in place to meet basic survival needs (e.g.
a UCT).
Adeso Sector-based Guidelines for Cash Transfer Programming
33
What are the costs associated with compliance with the conditions (school fees, school
materials, uniforms etc.)?
How many children are to be targeted in the household? Does the program enable
amounts to be varied between households according to the number of participating
children?
Should payments vary according to the stage of schooling (primary or secondary) e.g.
by providing higher payments for secondary students? Both Mexico and Colombia
provide higher payments for secondary school students, reflecting the greater cost of
lost employment from remaining in school. Under the Oportunidades program, cash
transfers to secondary students are over three times that provided to primary students,
since the latter are much more likely to attend school even without the transfer.
Should there be annual lump-sum payments (for fees or school materials) in addition
to regular ‘attendance’ payments? If so, should this again be higher for secondary than
primary students?
Should grants vary between genders? Some programs give higher educational grants
for girls, reflecting observations that in rural areas girls were more likely than boys to
drop-out.
Targeting
Targeting for CCT programs for education faces a trade-off between poverty/vulnerability
targeting and targeting on the basis of educational criteria. For example, if low school
enrollment is used as the main factor in targeting geographical areas/school catchments,
the education impacts are likely to be greater (due to starting from a lower baseline) but the
program may not reach the poorest or most vulnerable areas, resulting in reduced impacts
on poverty. If the focus is on targeting areas with the highest poverty levels, the inclusion
of households with relatively higher enrollment rates will reduce the educational impacts.
Selection processes which exclude children who already attend school regularly may be
perceived as penalizing households for previous investments in their children’s education
and ‘rewarding’ households who have not prioritized this expenditure.
To date, most programs have combined some form of geographical targeting with a means
test to identify the poorest households within the target area.
Some programs only target areas with adequate levels of service provision, where the
current educational infrastructure is able to meet increased demand without reducing
the quality of educational provision. In areas where increased demand is likely to lead to
a decline in the quality of education provided, increasing demand without accompanying
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Adeso Sector-based Guidelines for Cash Transfer Programming
measures to increase capacity/maintain quality will disadvantage those children already in
education, leading to unintended negative impacts.
Complementary Programs
Cash and voucher programs are not a ‘cure all’ for addressing all barriers to access to
education (informational, cultural, physical, administrative, discrimination in access). They
must be complemented by information and education campaigns raising awareness of the
importance of education, service improvements, and strategies to address other barriers
e.g.:
Physical barriers (e.g. distance to schools).
Administrative barriers (e.g. lack of birth registration, which may be required for
enrollment).
Cultural barriers, such as attitudes to girls’ education, or inclusion of disabled children.
Inadequate levels of provision of school facilities (quality or quantity).
Where poor or excluded households and children lack the required documentation of
identity or status for enrollment in education, measures to facilitate birth registration may be
required. This approach has been used in Zimbabwe, by the implementing NGO partnering
with the Department of Social Services to secure birth certificates for unregistered children.
Cash transfers for education are most effective when complemented by measures to
improve the provision of education services. Programs which increase the demand for
educational services have their limits if used in isolation, as a rapid expansion in use can
undermine service quality unless there is also increased investment in service provision.
Increasing the effectiveness of programs may require government initiatives to improve the
supply of education resources in the target area. This is would require close coordination
and partnership between implementing agencies and the responsible Government
Departments.
It can strengthen education programs if regular training or family development sessions are
conducted for carers to raise their awareness of the importance of education in alleviating
poverty, and to increase understanding of the program’s long-term objectives. This can also
provide a channel for feedback of information, including providing a potential additional
source of information on program impacts. Attendance may be included in the compliance
conditions for receipt of payments.
Adeso Sector-based Guidelines for Cash Transfer Programming
35
Monitoring and Evaluation
Where a program contains multiple interventions (e.g. cash grants, school feeding,
improvement of quality/quantity of school facilities etc.), it is difficult to identify how
much of the observed benefit is attributable to each of the elements of the program.
Monitored indicators should be easily verifiable and not require unnecessary discretion
to be used by monitoring staff.
Monitor impacts on children by gender, so it is possible to see if any gender
discrimination is occurring in enrollment of children in the program, or in outcomes.
Awareness of the current and former health status of children can be an important
consideration in monitoring educational impacts. Formerly malnourished children or
children with chronic disease may be unable to achieve the same levels of educational
attainment as other children.
Can education outcomes (e.g. pass rates) – rather than just activities (school attendance)
- be evaluated?
Monitor impacts on non-participants to ensure that they are not being ‘crowded out’
of education by increased usage rates.
Monitor any impacts (positive or negative) on levels of education service provision and
quality, even when no supply-side measures are included in the program.
Do non-participants previously attending school feel service provision or quality has
been affected?
Further Reading
Adeso, 2012. A Practical Guide to Cash-Based Responses
Chapman, K., 2006.Using Social Transfers to Scale Up Equitable Access to Education and
Health Services. Background Paper. Scaling Up Services Team, DFID Policy Division. UK
Department for International Development.
Saaverda, J.E., and S. Garcia, 2012. Impacts of Conditional cash Transfer Programs on
Educational Outcomes in Developing Countries. A Meta-analysis. Working Paper WR-9211. February 2012. RAND Labour and Population Working Paper Series.
J-PAL Policy Briefcase. 2012. Redesigning Conditional Cash Transfers. Cambridge, MA:
Abdul Latif Jameel Poverty Action Lab.
Barrera-Osorio, F., M. Bertrand, L. Linden, and F. Perez-Calle. 2011. Improving the Design
of Conditional Transfer Programs: Evidence from a Randomized Education Experiment in
Colombia. American Economic Journal: Applied Economics. 3(April): 167-95.
EPRI, 2011. Designing and Implementing Social Transfer Programmes: a policy manual.
Chapter 9. Designing Conditional Cash Transfer Schemes. Economic Policy Research
Institute. Various resources on the Cash Learning Partnership website at: www.cashlearning.
org IFRC / ICRC, 2011. Guidelines for Cash Transfer Programming
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Adeso Sector-based Guidelines for Cash Transfer Programming
Designing a CCT with Educational Objectives: Practical Tips
1.
Check if your assumptions about why children are not attending school are correct.
What are the principal barriers preventing children attending school? e.g. is mainly
due to poverty, or high costs associated with school attendance, or loss of the child’s
earned income as a result of school attendance? Or is poor availability of quality
schools, teachers or materials and resources within schools the problem? Is lack of
awareness of benefits of children’s education affecting uptake? Are there any cultural
issues, such as attitudes to girls’ education?
2.
Clearly identify the educational outcomes you want to achieve. Is a cash transfer the
best tool to achieve these objectives? If so, which of these outcomes can be achieved
without conditions? e.g. would an unconditional transfer (to make education more
affordable and offset lost child income) accompanied by a fee waiver scheme achieve
the desired outcome? Which of the objectives would be better achieved through a
CCT? Remember! - applying conditions has costs for the agency (monitoring) and
for the beneficiary (e.g. time, money spent in complying) and should therefore only be
applied where they are expected to significantly increase impacts.
3. What complementary programs are required? These are critically important for
achieving education, health and nutrition outcomes, (e.g. information and education
campaigns).
4. Don’t forget the supply-side!
Conditioning transfers on school attendance or
enrolment assumes an adequate service available to access; this must be confirmed
before beginning programming. If the Cash Transfers are conditional on attending
school, local schools must be functioning, safe, easily accessible and have to have
capacity to include new participants. Are local schools of adequate quality to produce
the intended effects? Attendance at poor quality schools may ‘tick’ the compliance
requirement without improving learning. If current supply is inadequate, or unable to
accommodate the extra demand without a decline in quality, what measures can be
taken to increase supply to meet beneficiary uptake? e.g. ‘teacher transfers’, grants to
schools to expand capacity / purchase materials, desks etc.
Adeso Sector-based Guidelines for Cash Transfer Programming
37
5.
Design conditions carefully. Conditions should not be too burdensome or beneficiaries
may not comply or may ‘opt-out’ of the program. When conditions are used, they
should be structured as simply as possible to achieve the intended result. Complex
conditions increase costs and complexity of monitoring, and are unlikely to be easily
understood by beneficiaries, reducing the likelihood of compliance. Are the very poor
or most vulnerable groups likely to have problems in complying with conditions?
6.
What should be the response to non-compliance? Should those who fail to comply
have their payments suspended, be excluded from the program, or be provided
with support / mentoring to encourage them to comply in future? It is important
to understand the reasons why the participant has failed to comply before applying
sanctions.
7.
Whether or not compliance is enforced it should always be evaluated. Recording and
monitoring systems needed to check levels of compliance with conditions should
always be in place, even if compliance is not enforced.
8.
Target those areas with the lowest school attendance levels and the very poor. Evidence
shows that educational impacts are greatest when starting from a low baseline (e.g.
low initial enrollment) and when the very poor are targeted. However, this assumes
that low use is not due to a lack of available school capacity or quality.
9. Learning outcomes need to be monitored- attendance alone is not a sufficient
indicator of learning. Programs should seek to monitor impacts (e.g. pass rates), not
just activities (attendance).
10. Document lessons learned. Record ‘lessons learned’ and recommendations to improve
future programs and share best practice.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Health
Photo Credit: Nicole Sobecki (© USAID)
Adeso Sector-based Guidelines for Cash Transfer Programming
39
Health
Why Give Cash and Voucher Incentives for Health?
Poor families in low income countries face a range of resource constraints and other
disincentives limiting their use of essential health care. Distance to health clinics, loss of
wages due to illness, costs of seeking care, user fees and out of pocket expenses can all
limit access to health care and information by those who need it most, especially in the
case of preventive health care. Cash-based approaches for health care are most commonly
used to address problems of lack of affordability and/or low demand, as cash transfers can
reduce barriers to health care use by enabling families to meet out-of-pocket expenditures
and opportunity costs.
Cash transfers for health can also be appropriate in emergency situations. Health care may
be a major expense for emergency-affected populations, at a time when their health needs
may be high and their asset base depleted or destroyed. This may result in harmful coping
strategies where long-term livelihoods and economic well-being is sacrificed in order to
meet urgent health needs. However, health care in emergency contexts often also involves
supply-side issues. In addition, health care conditions aimed at promoting behavior change
are generally most relevant in longer term interventions and may not be appropriate in
emergency settings. Consequently, cash programs aimed at health care are most commonly
found in recovery and developmental contexts rather than in emergencies. Most of these
cash programs seek to induce changes in health behavior by providing cash transfers on
the condition of use against preventive health services, often combined with attendance at
health education talks.
There is strong evidence from various countries that cash transfers have generated sizeable
gains in access to health services. This is measured by increases in use of health services,
especially preventive health, and health monitoring for children and pregnant women.
Fewer studies have measured impacts on health status, as measured by incidences of
illness/morbidity or mortality, but where this has been assessed results have also generally
been very positive. Impacts are typically larger in countries with lower baseline levels of
preventive health care use.
Cash transfers can help overcome barriers to use of health services, leading to increased
uptake, especially of health monitoring and preventive services. In addition to treatment
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Adeso Sector-based Guidelines for Cash Transfer Programming
charges, poor households face significant indirect costs, such as travel costs to clinics and
income lost from time off work. Other justifications for cash transfer programs imposing
health conditions are:
a)
Poor households lack adequate information on the long-term benefits of preventive
health care, and so must be encouraged by CCTs to make better use of services, or
b) Benefits to society from increased uptake of health services (e.g. reduced spread of
infections)
There are often close interactions between programs for health, education, and nutrition. As
a result, many programs seek to target these sectors together, often under the objective of
‘human capital development’ and promoting the achievement of Millennium Development
Goals.
How Can Cash and Vouchers Be Used to Promote Health?
There are various ways in which cash and vouchers can be used to improve access to health
care:
Target populations can be provided with cash grants or vouchers to cover some or all
of the costs of health care.
Even where expenditure on health care is reduced through removing user fees in an
emergency, other hidden costs, such as transport, can remain. Cash grants could help
to meet these other costs associated with accessing healthcare.
Cash or vouchers to purchase specific health-related goods such as treated mosquito
nets.
Cash for Work programs can be used to assist in the construction of health facilities/
clinics.
Cash grants may be made to communities or committees for the construction of
health facilities.
Adeso Sector-based Guidelines for Cash Transfer Programming
41
Examples of Using Cash and/or Vouchers in the Health Sector
Promoting and supporting Directly
access
to
services
providing
pre- Interventions
improving
by defined goods or services access to health by targeting
children and their families through cash or vouchers.
other points in the supply
through provision of cash or
chain.
vouchers.
CCTs can be conditional on: “Treatment vouchers” to be
Attendance at antenatal
checks.
can
Child growth monitoring
medical treatments.
treatments e.g. by improving
Cash and/or vouchers for:
Health related goods e.g.
Adult(s) attending health
mosquito nets.
education talks.
Transportation to health
facilities.
births.
Adherence to treatment
regimes e.g. for ARVs or
TB treatment.
of
of
the
effectiveness
at clinic.
attended
increase
redeemed against specific
nutrition
Child vaccinations.
Institutionally
UCTs
health
patients
on
ARVs.
CfW to refurbish or construct
health facilities.
CfW to provide or improve
WASH
and
facilities
sanitation
can
also
improve health status of
communities.
UCTs can be used to make
access to health care more
affordable.
In addition to programs designed with explicit health objectives, initiatives which alleviate
poverty or target other aspects of household wellbeing can have ‘spill-over’ effects on
health outcomes. This is illustrated in Health Case Study 1 outlining a project carried out in
Malawi. A holistic view which recognizes linkages between sectors is required in both the
design and assessment of cash transfer programs for health.
Health Case Study 1:
Zomba Educational CCT Reduces HIV Infection
A World Bank study in Zomba, Malawi, that gave cash transfers linked to girls’ school
attendance found a decrease in girls’ risk of HIV and other STIs (60% reduction after
18 months among girls receiving cash transfers). In addition, there was evidence that
participants were three to four times more likely to be in school at the end of the school
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Adeso Sector-based Guidelines for Cash Transfer Programming
year and more likely to delay marriage and pregnancy. Participants not only had less sex, but
when they did, they tended to choose younger, safer partners. The cash transfers may also
have led to reductions in transactional sex.
The study targeted nearly 4,000 girls and young women aged between 13 and 22 from
Zomba, a district in Malawi with high HIV and school dropout rates among adolescent girls.
The only condition for receiving cash payments every month was that the girls enrolled in
the programme had to attend school regularly. Their parents also received cash payments.
The girls’ school attendance was checked every month and the payment withheld if
the student’s attendance rate was below 75% in the previous month. Although the cash
payments were only conditional on school attendance, results showed the payments also
made the girls less vulnerable to contracting HIV and other STIs. This illustrates the multisectoral nature of impacts of cash-based interventions.
Source: S. Baird, R. Garfein, C.McIntosh, B. Özler 2012. Effect of a cash transfer programme
for schooling on prevalence of HIV and herpes simplex type 2 in Malawi. Lancet 2012; 379:
1320–29
Unconditional Cash Transfers
Providing the poor with Unconditional Cash Transfers can improve their health in a number
of ways:
Cash transfers make health care more affordable.
By increasing household incomes, UCTs generally improve nutritional levels, which can
lead to an increase in personal health and a reduction in conditions such as stunting
or illnesses related to malnutrition, and an improvement in cognitive development of
young children.
Where beneficiaries use the money to improve their housing and personal well-being,
their health outcomes may also improve.
Unconditional Cash Transfers are more likely to generate health benefits and expenditures
when vulnerable groups have access to sufficient information to make informed choices
about health.
A further reason for providing an unconditional cash component in health programs is that
the poorest households must be able to reach a minimum threshold of food consumption
before they can consider making investments in health expenditures, particularly preventive
Adeso Sector-based Guidelines for Cash Transfer Programming
43
health expenditures. In addition, better nutritional status can increase the effectiveness of
health treatments.
Unconditional Cash Transfers may also be the appropriate response where service coverage
is poor and compliance difficult. Unconditional transfers should at least improve children’s
nutrition and physical and cognitive development, leading to better general health.
Conditional Cash Transfers
The imposition of conditions related to health care use is usually based on the following
assumptions:
1)
The use of health services by poor households is below the ideal level. This is usually
assumed to be due to the costs involved in using these services being less affordable
for the poor.
2)
Lack of awareness or understanding of health issues among the poor contributes to
the under-use of available health services.
3)
The use of conditions is necessary to promote the optimal level of use, by requiring
attendance at health checks, health education talks etc. This assumes that the
increased income brought about by an Unconditional Cash Transfer will not, in itself,
be enough to cause the desired change in health-related behavior (e.g. attendance at
clinics, vaccinations etc.).
4)
The desired health service is available and able to accommodate increased demand.
If this is not the case, conditioning the cash transfer on the use of the service may
be counter-productive, possibly leading to a fall in the quality of available services
due to inability to cope with the increased demand, or difficulties for beneficiaries in
complying with the conditions.
5)
Increased use of health services will improve health status. Whether or not attendance
at clinics actually leads to improved health status will strongly depend on the quality
of the health services available and whether participants understand and comply with
treatments received.
CCTs may work partly through providing information to recipients (e.g. the benefits of health
checkups) and partly through their effect on increasing household incomes. Agencies
should consider if their aims could be achieved using a UCT with health education, thereby
avoiding the cost of monitoring compliance with CCT conditions.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Consideration should be given to the ability of vulnerable or marginalized groups to comply
with conditions. For example, some minority cultural groups find it more difficult complying
with CCT conditions due to language and cultural barriers.
Vouchers
For items which require strict quality standards, vouchers redeemable at shops contracted
to provide the required quality may be preferable to unconditional cash, where quality
cannot always be guaranteed in public markets (e.g. pre-treated mosquito nets).
Cash for Work
Cash for Work can also be referred to as a Conditional Cash Transfer, and can be used
to contribute to increased supply or capacity of health services through assisting with
refurbishment or construction of health facilities.
Health Case Study 2:
Vouchers for Hygiene Kits after the 2010 Haiti Earthquake
In response to the 2010 Haiti earthquake, Oxfam International implemented a program to
improve health conditions by facilitating access to hygiene kits for vulnerable families. This
used a system of ‘commodity vouchers’ redeemable at specified shops for a fixed quantity
of specified hygiene commodities (soap, toothpaste, toilet paper, sanitary pads, a bucket
and a large basin). Although ‘cash vouchers’ would have allowed beneficiaries more choice
in selecting hygiene items to meet their specific needs, vouchers were used to:
Ensure that the assistance was only used for specified hygiene goods.
Avoid the massive challenge and security risks of in-kind distributions.
Make the pilot more manageable.
In recognition that small shops were not prepared to deal with stocking a greater
diversity of items in increased quantities.
To increase flexibility and avoid congestion in shops, beneficiaries had three to four days
to redeem their vouchers. The hygiene kit vouchers were part of a larger program that
included training and public health promotion activities.
Adeso Sector-based Guidelines for Cash Transfer Programming
45
Key Lessons Learned
Voucher programs are time-intensive, especially when staff, beneficiaries and/or traders
are unfamiliar with the approach. As such, they are difficult to implement in immediate
first phase emergency response unless staff already have the required skills. It is important
to invest in preparedness for CTPs in disaster prone areas to ensure a timely response to
disasters.
Agencies should invest in developing systematic integration between sector-based
teams to maximize use of resources, for example by undertaking integrated assessments
and evaluations. The inclusion of hygiene items into the Emergency Food Security and
Livelihoods-led market assessment was a key factor enabling this pilot to be undertaken.
Commodity vouchers restrict beneficiaries’ choice compared to cash vouchers, which
would have allowed them to select hygiene items up to a specified cash value. However,
commodity vouchers were considered ‘less risky’ for small traders, who may be unsure how
well unfamiliar products will sell.
111 of the families initially selected could not participate in the project due to the lack of a
suitable local trader. A voucher fair approach can be used to overcome a lack of suitable
local traders.
Source: Oxfam GB, 2011. CaLP Case Study: Shop vouchers for hygiene kits in Port-auPrince, Haiti. http://www.cashlearning.org/downloads/resources/casestudies/CaLP_Haiti_
Case_Study.pdf
Assessing Appropriateness
Preconditions for Using Cash and Vouchers for Health
Minimum levels of availability and quality of health services are a precondition for measures
such as CCTs which are conditioned on the use of these services. Healthcare services must
be safe and easy to access for participants, and be able to accommodate the increase
in demand. Alternatively, the resources and will must exist to increased availability of
healthcare provision to accommodate the expected increase in demand, and provide the
required quality of healthcare necessary to achieve the desired health outcomes. Where
healthcare provision requires to be enhanced to meet the needs of the program, this must
be done before the implementation of the CCT.
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Adeso Sector-based Guidelines for Cash Transfer Programming
The reasons for low uptake of health care services must be accurately identified to ensure that
the program design is targeted to overcome the key barriers to use. Failure to correctly identify
barriers to heath care use is likely to result in programs which prove ineffective or inefficient.
Identify Reasons for Low Uptake of Health Services
An essential prerequisite for designing a program to address low uptake of health care services
amongst the poor is a thorough assessment of the reasons for lack of participation in health
care. This should also identify and address the different barriers preventing males and females
from accessing health services, as well as men and women’s distinct health care needs and
health-seeking practices. Failure to correctly identify the underlying causes of low health care
use will lead to inappropriately designed interventions which fail to address the key issues,
undermining program effectiveness.
Adeso Sector-based Guidelines for Cash Transfer Programming
47
Why is Uptake of Health Care Services Low?
Will Conditions Improve Health Outcomes?
Conditions are more likely to have a maintained effect if they are monitored and enforced.
Where compliance is monitored, it is usually very high. However, not all programs enforce
conditions. There is some evidence that merely informing people of the condition and
implying it will be monitored increases compliance, even if actual monitoring is omitted. This
may be due to the condition signaling the importance of the activity, or due to an implied
risk of losing the benefit. This may suggest that intensive monitoring is not always essential
in order to achieve an effect. However, it is uncertain how long these effects of ‘suggestion’
would be maintained in the absence of some action that suggests to beneficiaries that
compliance monitoring is actually taking place.
Conditions which are complex are unlikely to be easily understood by beneficiaries, thus
reducing the likelihood of compliance, in addition to increasing the costs and complexity
of monitoring.
The following table provides guidance on situations where conditions for health objectives
are most likely to be successful in improving health outcomes, and when they are likely to
be least effective.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Factors Affecting the Impact of Conditions on Health Outcomes
Environmental
Factors likely to improve
Factors likely to reduce impact
Conditions
the impact of conditions on
of conditions on program
program outcomes
outcomes
Current demand
If
current
uptake
of
health If current uptake of health services
for human
services starts from a low baseline - e.g. vaccination rates - is high,
capital (e.g. clinic of use, impacts of CCT programs there will be limited scope for
attendance).
are likely to be higher.
CCTs to increase uptake.
Level of provision Good level of proximity and Low proximity and accessibility of
of health
accessibility
of
health
care health care facilities.
infrastructure
facilities.
(clinics,
Good quality of available services. lack of skilled staff so that
medicines,
Good capacity of services to attendance is not translated into
vaccinations).
absorb extra demand.
Poor quality of available services,
positive health outcomes.
Low capacity of services to absorb
extra demand, with associated risk
of decline in quality if attendance
rates increase.
Capacity for
Agencies have, or can easily
If administrative capacity is weak.
Administration.
acquire, the administrative
Lack of capacity to accurately
capacity to implement the
monitor compliance.
program and monitoring
conditions.
Ability
of
poor Beneficiaries
are
easily
able If resources or circumstances
b e n e f i c i a r i e s to access services required to inhibit beneficiaries from easily
to
respond
conditions.
to respond to the incentives created responding to incentives. e.g.
by cash transfers e.g. clinics clinics are far from beneficiaries,
are easily accessible, and have increasing
capacity/quality of provision.
effort involved etc.
Good
Design.
increase compliance and impacts excluding the poorest and most
where
design
costs,
Program
e.g.
program
compliance
failure
to
can Rigidly imposed conditions risk
meet vulnerable who find it hardest to
conditions triggers intermediation comply. Automatic benefit cuts
services that support households implemented without remedial
in complying.
support can compound problems
Combining UCT or CCT with that led to non-compliance.
information
and
education
campaigns.
Adeso Sector-based Guidelines for Cash Transfer Programming
49
Exit Strategy and Sustainability
NGOs embarking on health care interventions need to carefully consider sustainability and
exit strategies. Unlike government where long term health care provision may be possible,
NGOs generally have very short program funding horizons. It is therefore essential to
identify how households are to be enabled to maintain their access to health care after the
program ends. To achieve this, two complementary funding streams/initiatives are likely to
be required:
1.
Donor funding for piloting approaches, identifying best practice, promoting rapid
development of techniques and capacity for scale-up.
2. Domestic/government funding and take-over of interventions for long-term
sustainability.
Potential Issues
If cash transfers are conditioned on health care services, it is essential to ensure that the
services provided are of adequate quality. Cash transfers could encourage people to seek
private health care or use private pharmacies. Eligible services (those classed as meeting
the conditions) should be restricted to those service providers where the quality of service
provision and drugs used can be guaranteed. There is also a danger that an increase in
demand, without increased availability of services, will increase the cost of services, such as
increases in user fees or medicine charges.
In Mexico, under the Progresa program, some medical staff were reported to be responding
inappropriately to high demand by charging program beneficiaries when a medical visit
was not related to the program. In some cases, medical staff would diagnose illness during
the free program consultation, but require beneficiaries to make an additional appointment
for treatment, which they were then charged for . It is important to be aware of these risks,
and ensure that they are checked for during monitoring. Prior agreements with clinics can
reduce the risk of ‘manipulation’ of the process by staff.
Availability and quality of medicines was a major issue in Mexico. Some public health
clinics used by the Oportunidades program had insufficient medicines available to treat the
increased number of patients. Beneficiaries also claimed that medicines provided by public
clinics were of low quality, resulting in many beneficiaries purchasing more expensive
higher quality drugs at private pharmacies.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Health Case Study 3:
How strictly should conditions be enforced?
Example from CCT for Child Health and Development, Manicaland, Zimbabwe
This study by Imperial College London and the Biomedical Research and Training Institute
of Zimbabwe investigated the child-level effects of Conditional and Unconditional Cash
Transfers on birth registration, vaccination uptake and school attendance. If a household
provided a good reason for not meeting conditions (e.g. missing school due to illness), this
was verified and judged on a case-by-case basis. Spot checks at schools and clinics were
also used to verify attendance.
To allow households time to begin meeting conditions, conditions were not enforced
during a six month “grace period” at the start of the project. After this time, households not
complying with conditions at the next check were offered support from the implementing
agency, DOMCCP, to help them comply. At the following check, if they were still in default,
a community volunteer was assigned to help them meet the conditions. If after another four
months the household remained in default, the amount of their transfer was reduced by 10%.
After six months of default the community volunteer assumed control of the household’s
transfers and managed the funds to assist the family in meeting the conditions e.g. covering
costs involved in complying. The situation was reviewed regularly, and if the household
began meeting conditions, the volunteer was removed and the household received their full
transfer. 35% (i.e. 341 out of 965) of eligible CCT households received help from a community
volunteer to help them meet the conditions. Enforcement of the conditions was relatively
“soft” – those defaulting received support with compliance rather than penalties, and rarely
had their transfers reduced or stopped.
Source: L. Robertson et al. 2013. Effects of unconditional and conditional cash transfers
on child health and development in Zimbabwe. The Lancet, Volume 381, Issue 9874, Pg
1283 - 1292, 13 April 2013
Supply-side Interventions
Programs which promote demand for health services require those services to be able
to increase supply in response to a rise in demand. Increasing demand for services in
circumstances where this is not the case could be at best ineffective and at worst counterproductive (e.g. if increased clinic attendance increases staff-patient ratios, leading to a
reduction in quality of health care for all). Where there are capacity or quality constraints
in health service provision, cash transfers need to be complemented by interventions to
improve service provision.
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51
In Honduras and Nicaragua, CCT programs included supply-side strengthening to mitigate
the pressures associated with increased demand for services and the possibility that quality
might decline due to higher demand. This involved contracting private providers to deliver
a package of health care services and health education talks in Nicaragua (at a cost of
$160 USD/beneficiary/year) and financial support to public health centers in Honduras
($6,000 USD/health centre/year). However, there were substantial delays encountered in
implementing supply-side activities.
If quality decreases, or non-beneficiaries are crowded out, the program may have negative
impacts that outweigh the gains from increased beneficiary attendance at clinics.
On the other hand, increased demand can sometimes be used to stimulate improvements
in efficiency and quality. CCT programs conditioned on use of public health facilities need
to coordinate closely with government agencies responsible for public health to ensure
services are enabled to meet the increased demand generated.
Consider Possible Negative Effects from
Targeting Criteria and Conditions
Targeting
Geographical targeting is frequently used
An exception to the usually positive effects of
in cash transfers for health outcomes,
CCT programs on child nutrition was reported
with poor localities identified as the first
for Bolsa Alimentacao (a pre-cursor to Bolsa
stage of the targeting process. Some
Familia) in Brazil. In northeast Brazil, monthly
programs then allow all households within
growth measurements for children under age
these localities to participate. However,
three revealed that each month of exposure to
geographical targeting is more often
the program reduced weight gain by 31 grams
accompanied by a means test. In addition,
compared to non-participant children. This
some programs limit participation to
negative effect of the nutrition program was
households with young children, school
believed to be due to the fact that mothers
age children or pregnant women.
thought that if their child began to grow, they
would be removed from the program. They thus
A review of targeting strategies found that
had an incentive to reduce the growth of their
the performance of means tests varied
child or to avoid providing the added nutrition
considerably according to the capacity of
provided by the program.
those administering them. However, they
did perform best in terms of minimizing
Although no other examples of unintended
errors of inclusion and exclusion, and
negative health effects have been found, this
were cost-effective. The benefits of
highlights
household level targeting are greatest
potential incentives for harmful behaviours when
in more heterogeneous communities.
setting targeting criteria or conditions.
the
importance
of
considering
Source: Glassman et al. 2007
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Adeso Sector-based Guidelines for Cash Transfer Programming
In relatively small, fairly homogeneous and very marginalized communities, geographical
targeting alone may be the most cost-effective approach . There are potential ethical issues
involved in excluding similarly poor households from participating in health care programs
in the latter context, and increased risks of causing feelings of resentment or tensions within
the community.
When targeting it is important to assess the proximity of suitable health care facilities
to the beneficiary population(s). If the level and/or quality of services available locally is
inadequate to meet the intended health outcomes, it will be necessary to address these
supply constraints if the intended health outcomes are to be received. Some past programs
only targeted locations where there was sufficient supply of health services to meet the
expected increased demand.
Explicit targeting of AIDS-orphans or AIDS-affected children risks stigmatizing vulnerable
children. However, targeting programs to the extreme poor using indicators that capture
AIDS-affected households (e.g. high dependency ratios or presence of a household member
with a chronic illness) can help programs reach children affected by AIDS whilst reducing
the risk of stigmatization.
Setting the Payment Rate
The simplest approach to setting the payment rate for health care programs is to calculate
the costs of accessing healthcare (transport, treatment fees, time lost from work etc.) and
to set the payment at a level which covers these costs. This approach is similar to that used
in the Honduras Family Allowance (PRAF) program.
A problem with the above approach is that it does not take account of other household
needs which also affect their health and well-being. Consequently, the needs assessment
process should focus on all household needs, not just health care aspects. Where key needs
– such as food and nutrition needs - are not being met, these should be addressed as part
of the program. Failure to do so will not only undermine key health outcomes, and will also
increase the likelihood of resources intended for clinic attendance being diverted to meet
basic needs such as food consumption.
Adeso Sector-based Guidelines for Cash Transfer Programming
53
It may therefore be desirable to set the payment rate at a level that is adequate to cover
households’ basic needs, plus costs of compliance, rather than just covering the costs of
compliance with the health care conditions. In Colombia, Jamaica and Mexico, the amount
of the health/nutrition transfer represents the difference between the average consumption
of a very poor household and the food poverty line, as a minimum consumption level was
seen as a pre-requisite to investment in human capital (health and education).
An appropriate approach to setting the payment rate is likely to be one which takes account
of the importance of meeting the households’ basic needs, in addition to addressing the
‘compliance costs’ of meeting the program conditions.
Health Case Study 4:
Progresa Conditional Cash Transfers for Health in Mexico
Social transfers can impact on health outcomes by improving nutrition and enhancing the
ability of those living in extreme poverty to access health services and pay for medicines
and other associated costs. Social transfer programs also provide evidence of sustainable
impacts on nutrition, with 70% of households participating in Progresa showing improved
nutritional status.
Significant findings are seen in Mexico where Progresa has brought about a 12 percent
reduction in the incidence of ill-health among children aged naught to five years compared
to non-Progresa children, and 19 percent fewer days of illness among adults. The program
also resulted in an eight percent increase in clinic visits by pregnant women in their first
trimester, and a 25 percent drop in the incidence of illness in newborns. Impacts on stunting
were also significant, with the growth rate among children aged 12-36 months increasing
by one centimetre per child, per year. This represented a 16 percent increase.
Quality issues must be addressed if gains from increases in use of health facilities are to be
achieved and sustained. Under Progresa, resources are now set aside to cover some of the
costs of additional health services demanded due to the program and ensure adequate
supply of equipment, medicines and materials. In addition, NGOs are used to supplement
government capacity for health care provision. Progresa only operates in areas where
adequate levels of health service provision (public and NGO) are available.
Source: K. Chapman, 2006. Using Social Transfers to Scale Up Equitable Access to
Education and Health services. DFID Policy Division. Background Paper. January 2006.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Complementary Programs
Complementary programs and services are centrally important for education, health
and nutrition outcomes. Most health interventions include health education programs.
Attendance at these health education activities is usually one of the conditions attached
to health CCTs. In addition to direct information related to the primary objective of the
intervention (vaccination, child growth monitoring etc.), these sessions frequently include
hygiene, nutrition, water and sanitation (WASH) topics.
In Mexico, the health talks are reinforced by peer-to-peer learning through the use of
“community mothers”, with positive results. It is also important to ensure that all information
campaigns are in the appropriate native language for the community concerned, and, where
required, reinforced by ‘poster’ campaigns to reinforce the key messages. In communities
with low literacy levels, poster campaigns can use ‘cartoon’/pictorial approaches to reinforce
the message.
Monitoring and Evaluation
Detailed guidance on monitoring and evaluation of cash for health projects is provided in
the Practical Tools Guide. However, key considerations include:
Can health outcomes (e.g. reduced illness) – and not just activities (clinic attendance) be evaluated? Examples of possible impact variables include:
o Number and gravity of health episodes.
o Decreases in frequency or duration of hospitalization.
o Reductions in stunting.
o Morbidity indicators.
o Incidences of diarrhea in the past 15 days among young children (e.g. under age five).
Monitor impacts on children by gender, so it is possible to see if any gender discrimination
is occurring in attendance of children at health care services or in health outcomes.
Monitored indicators should be easily and objectively verifiable and not require
unnecessary discretion to be used by monitoring staff (i.e. not subjective opinions).
Monitoring should check for any negative impacts on non-participants, such as
crowding them out of ‘approved’ health care facilities and potentially diverting them to
‘sub-standard’ facilities.
Adeso Sector-based Guidelines for Cash Transfer Programming
55
Where the program directs people to public health care facilities, monitor changes
in usage of other health care providers (e.g. private clinics) to assess if one provider is
simply displacing the other.
Monitor any impacts (positive or negative) on levels of health care service provision
and quality, even when no supply-side measures are included in the program.
Assess ‘spill-over’ effects on non-participants that occur through ‘demonstration
effects’ of observing participants’ actions, or sharing of knowledge from IEC campaigns.
Failure to do so may lead to an under-estimation of program impacts.
Where a program contains multiple interventions (e.g. cash grants, education campaigns,
improvement of quality/quantity of health facilities etc.) it can be difficult to identify how
much of the observed benefit is attributable to each of the elements of the program.
Whilst the motivation for increased health care utilization and improved health outcomes
may be assumed to be due to the program conditions, they could also be a result of other
factors such as increased knowledge and awareness of health care issues from IECs,
provision of nutritional supplements in public health centers, increased income from the
cash transfer increasing affordability of health care and improving nutritional status, or
improved supply/quality etc. In order to determine not only what impacts the program
achieved, but also how and why, household surveys can be used to collect information on
attitudinal changes and behaviors, especially those related to health.
Further Reading
Adeso, 2012. A Practical Guide to Cash-based Responses
Chapman, K., 2006.Using Social Transfers to Scale Up Equitable Access to Education and
Health Services. Background Paper. UK Department for International Development.
Glassman, A., J. Todd and M. Gaarder, 2007. Performance Based Incentives for Health:
Conditional Cash Transfer Programs in Latin America and the Caribbean. Centre for Global
Development. CGD Working Paper # 120. April 2007
Sphere 2011 guidelines for minimum standards in health actions are available at www.
spherehandbook.org/en/minimum-standards-in-health-action/
IFRC/ICRC, 2011. Guidelines for Cash Transfer Programming
Various resources on the Cash Learning Partnership website at: www.cashlearning.org
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Adeso Sector-based Guidelines for Cash Transfer Programming
Designing a CCT with Health Objectives: Practical Tips
1.
Check if your assumptions about under-utilization of health services hold. For example,
are preventive health services under-utilized by the poor? Do the very poor use these
services less than other groups? What are the principle barriers preventing use e.g. is
poverty or the high costs associated with accessing care the main problem? Or is poor
availability or quality of facilities (e.g. clinics) or materials and resources within them
(e.g. lack of medicines, staff, equipment etc.) the problem? Or is lack of knowledge of
available treatments, their benefits and their proper use affecting uptake? Are there any
cultural or religious barriers to beneficiaries using the service (e.g. religious objections
to vaccinations)?
2. Clearly identify the effects you want the program to achieve. Which of these
outcomes can be received without conditions e.g. could stunting be reduced using an
unconditional transfer for improving general household nutrition, or is attendance for
growth monitoring required? Which of the desired effects would be better achieved
through a Conditional Cash Transfer? Remember! Applying conditions has costs for
the agency (monitoring) and for the beneficiary (e.g. time, money spent in complying)
and should therefore only be applied where they are expected to significantly increase
impacts.
3. What complementary programs are required? These are critically important for
achieving education, health and nutrition outcomes (e.g. information and education
campaigns).
4.
Don’t forget the supply-side! The health service or activity that the cash transfer is
conditioned upon must be functioning, safe, easily accessible and have the capacity
to include new participants. Are the services available locally of adequate quality to
produce the intended effects? Attendance at poor quality health facilities may ‘tick’
the compliance requirement without improving health outcomes. If current supply
is inadequate, or unable to accommodate the extra demand without a decline in
quality, what measures can be taken to increase supply to meet beneficiary uptake e.g.
contracting an NGO to provide supplementary treatment facilities or resources?
Adeso Sector-based Guidelines for Cash Transfer Programming
57
5.
Design conditions carefully. Conditions should not be too burdensome or beneficiaries
may not comply or may ‘opt-out’ of the program. Conditions should be relevant to
the intended effects. When conditions are used, they should be structured as simply
as possible to achieve the intended result. Complex conditions increase costs and
complexity of monitoring, and are unlikely to be easily understood by beneficiaries,
reducing the likelihood of compliance. Are the very poor or most vulnerable groups
likely to have problems in complying with conditions?
6.
What should be the response to non-compliance? Should those who fail to comply
have their payments suspended, be excluded from the program, or be provided with
support/mentoring to encourage them to comply in the future? It is important to
understand the reasons why the participant has failed to comply before applying
sanctions, especially loss of money, to poor or vulnerable households, possibly
denying them access to health care.
7.
Whether or not compliance is enforced, it should always be evaluated. Recording and
monitoring systems needed to check levels of compliance with conditions should
always be in place, even if compliance is not enforced.
8.
Target the very poor and those with the lowest utilization levels. Evidence shows that
health program effects are greatest when the extremely poor are targeted, and that
increases in uptake from CCT are larger when starting from a very low base level.
However, this is dependent on the reason for low uptake not being lack of available
supply of quality services.
9.
Learn from previous programs. When designing programs, it is useful to review what
has been used elsewhere in similar programs, and what has worked well.
10. Document lessons learned. Record ‘lessons learned’ and recommendations to improve
future programs and share best practice.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Shelter
Photo Credit: Tugela Ridley (© Adeso)
Adeso Sector-based Guidelines for Cash Transfer Programming
59
Shelter
Overview of Cash and Vouchers for Shelter
Although shelter responses after disasters traditionally involve in-kind aid (e.g. in-kind
provision of building materials, or employing contractors to rebuild houses), the use of
cash payments in shelter programs is also well established. In particular, labor payments
have long been a common part of many shelter interventions, even when materials were
provided as in-kind. More recently, agencies have been moving towards increasingly wider
use of the cash component of shelter projects, including payments to enable the purchase
of materials to be made directly by beneficiaries. Cash programs to help people obtain
temporary shelters or to rebuild damaged or destroyed homes are thus well established.
Cash grants have been used to enable displaced families to find temporary shelter through
staying with host families (rent support, or support to host families to build/repair shelters
for displaced families on their land), and as an alternative to in-kind provision of construction
materials. For permanent shelter needs, cash grants provide an alternative to the in-kind
provision of shelter materials or provision of contractor-built houses. This is known as an
‘owner-driven’ approach, as opposed to ‘donor-driven’, reflecting the shift in decisionmaking and empowerment to the recipients.
Why Give Cash and Voucher Incentives for Shelter?
Cash for shelter can be an effective way to offer prompt support to vulnerable families who
are displaced or have had their homes destroyed by natural disasters. The procurement
processes of humanitarian organizations can involve significant delays, which increase the
time-lag involved in implementing in-kind shelter projects. In addition, cash grants can:
Provide flexibility and choice in shelter design, enabling recipients to construct
dwellings that meet their families’ diverse needs.
Provide choice in materials used to build or repair housing.
Avoid contractor-driven reconstruction in favor of an owner-driven approach. This
may release more funds for assistance, and can direct money towards local markets
instead of larger companies.
Be cost-effective for implementing agencies.
Encourage people out of camps through grants, enabling them to rent etc. This is
particularly relevant in urban settings, where the potential rental resource is likely to be
greater.
60
Support community solidarity through recompensing host families.
Stimulate local economies through increased purchasing power.
Promote skills development (construction and repair skills) within communities.
Adeso Sector-based Guidelines for Cash Transfer Programming
In general, recipients can modify basic shelter designs to meet their needs as long as they
comply with certain prescribed standards and guidelines to ensure structural integrity,
quality standards, and Disaster Risk Reduction (DRR) requirements (e.g. earthquake resistant).
How Can Cash and Vouchers Be Used to Meet Shelter Needs?
Unconditional Cash Transfers are relatively uncommon in shelter projects, mainly due to
the larger sums involved in the transfers. Accountability for these larger sums requires
greater assurances for donors and implementing agencies that the funds were used for the
intended purposes, leading to staged payments and conditions on use.
Where households’ basic survival needs are not being met, it is likely that some or all of
any funds they receive for shelter purposes will be diverted to meeting these urgent needs,
such as food, in order to ensure survival. To avoid this risk, the project should also address
the issue of how households are to be enabled to meet these other urgent needs, possibly
though adding an unconditional ‘supplement’ to the cash grant to cover these needs, or by
providing in-kind aid.
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61
Examples of Using Cash and/or Vouchers in the Shelter Sector
Indirect
Interventions
Interventions Directly Targeting Beneficiaries
Promoting and supporting access to shelter Directly
providing
pre- I n t e r v e n t i o n s
by children and their families through defined goods or services improving
provision of cash or vouchers.
access
through cash or vouchers to shelter through
targeting
other
points in the supply
chain
Cash grants (conditional or unconditional):
Vouchers (cash or
Cash
for
To provide standard, disaster resistant
commodity-based) to
projects can give
core shelters.
provide:
people
a
Work
chance
To buy construction materials and
Shelter materials for
to earn an income
services.
repairs or reconstruction.
while
To strengthen and repair homes.
Construction materials
their
To further increase the size of homes
for new shelters.
by building latrines
Cash grants to kick-start construction,
Ancillary goods such as
and clearing rubble.
not complete funds for reconstruction.
tools.
improving
environment
To hire construction labor.
Compensate people for time spent
rebuilding their houses.
Carry out community works e.g.
rebuilding the homes of the vulnerable
who cannot do the work themselves.
Conditional Cash Transfers (CCT)
CCT schemes to meet shelter needs mostly fall under one of the following headings:
Cash or vouchers provided for the purchase of construction materials, labor etc.
CfW programs in which groups or individuals receive cash for working on (re)building
shelters and associated sanitary facilities.
Cash support to host families taking in displaced households. This can include:
o Cash for rent.
o Cash grants to host families to refurbish accommodation or buildings to 62
accommodate displaced families.
Adeso Sector-based Guidelines for Cash Transfer Programming
In some cases, the cash transfers are used to “kick-start” shelter construction, and do not
provide complete funds for reconstruction - they are just intended to enable families to
‘get started’, after which they are expected to complete the work from their own resources.
However, most projects see the process through to completion of the shelter to the point
where the family is able to move in.
A range of approaches can be used when applying conditions for shelter grants. Most
of these are based on staged payments, with each stage requiring completion to agreed
quality standards before the next payment is made. Often the first part of a construction
will involve clearing ground and digging foundations. This work is labor intensive but can
often be easily done by beneficiaries. Completing this work may sometimes be regarded as
sufficient indication of beneficiary commitment to allow release of a first payment.
In Vietnam, beneficiaries were required to purchase some building materials and have them
delivered to their home prior to the distribution date for the cash transfer . To facilitate
this, local suppliers were provided with a guarantee that payment for the materials would
be made a few days after delivery. The agency (Save the Children) then paid the suppliers
directly for the materials.
Vouchers
The agency may want to direct beneficiaries to pre-selected suppliers to help guarantee
quality of materials. If considered necessary, this can be enforced using voucher based
approaches with vouchers only redeemable at approved suppliers, or at organized ‘shelter
fairs’ where suppliers are invited to a specified location to set up a ‘shelter market’, and
beneficiaries also attend to redeem their vouchers (value or commodity vouchers) against
construction goods. Voucher fairs:
Allow beneficiaries to choose goods of guaranteed quality from different traders.
Provide a boost to the traders, who are usually from the local area.
Are relatively simple and cost-effective to organize.
Allow agencies to track which materials are prioritized by beneficiaries.
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63
Cash for Work (CfW)
Cash for Work can also be referred to as a Conditional Cash Transfer, and can be used
in shelter programs to ‘pay’ recipients for time spent working on the rebuilding of their
house. CfW can also be used to clear debris from communal areas, and restore damaged
community infrastructure, roads, etc. Shelter delivery using CfW is likely to be more rapid
if ‘piece work’ rather than daily payment rates are used. Incentives generated mean that
output will tend to be lower for day-rates compared to payment of a set amount per shelter
completed. Whilst ‘day rates’ may provide an incentive for workers to ‘prolong’ the project
to obtain increased remuneration, ‘piece-work’ rates which include compliance quality
criteria will create incentives for the rapid completion of shelters to required standards.
Shelter Case Study 1:
Factors Affecting Compliance with Transfer Conditions in India
The Indira Housing Scheme in India (Indira Awaas Yojana) had a budget allocation of $6bn
USD for the five year period 2007-12. It is the largest of several Indian schemes targeting
the national shortage of housing that meets basic standards (currently estimated at some
15 million units). For most areas, it has provided a grant (in installments) of approximately
$600 USD per beneficiary household. The staging of payments is intended to reinforce
compliance with conditions. Despite this, incomplete compliance with conditions remains
common, for complex reasons which include:
Until major increases in 2008, the sum allowed for construction or refurbishment was
inadequate. In some States this sum was further reduced as governments switched
funds into schemes unrelated to housing, or converted part of the grant into a loan. As
a result of inadequate funds, some beneficiaries left the work unfinished, whilst others
borrowed money to complete the work, but got into difficulty and failed to complete.
A third category abandoned the work early on, and failed to obtain later installments,
but spent most of the first installment on other priorities.
In 60% of cases, beneficiaries did not have land to build on, and the government was
slow or unable to provide it, so they tended to reallocate the monies received. The
lack of plots, especially among the poorest, contributed to a tendency to switch funds
away from the intended purpose.
Requirements to incorporate a smokeless hearth and sanitary latrine into house
construction were met, according to one estimate, in only 50% and 57% of cases
respectively. This was is in some cases due to widespread cultural resistance to having
a kitchen and (especially) a toilet within the house.
Source: J. Farrington and R. Slater, 2009. Lump Sum Cash Transfers in Developmental
and Post-Emergency Contexts: How well have they Performed? Overseas Development
Institute (ODI)
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Adeso Sector-based Guidelines for Cash Transfer Programming
Assessing Appropriateness
Preconditions for Using Cash and Vouchers for Shelter
Key requirements to be considered before implementing cash-based programs for shelter
include:
Carefully assess all the needs of the household (shelter, food security, water etc.).
Based on this needs assessment, decide if cash is the most appropriate response to
meeting these needs.
Consider land use rights. Ensure recipient has security of tenure on the land where
the shelter is to be built, either through ownership, legal lease or equivalent (usually at
least one to three years).
If providing support to host families to refurbish accommodation/extend their house
to accommodate displaced families, ensure security of tenure for the displaced family
through a formal lease, or a tri-partite agreement between landlord, tenant and NGO
etc. to prevent eviction occurring once the refurbishment work is completed. Involving
local leaders can also help prevent unfair treatment of displaced families.
If using cash for hosting, an assessment of the local housing rental market will be
required.
The suitability, safety and security of any proposed accommodation provided through
hosting arrangements must be assessed, and adequate security of tenure obtained
(e.g. leases).
The required shelter items (materials, tradesmen, rented accommodation etc.) need
to be locally available for purchase from markets/traders without causing negative
impacts such as price inflation or environmental degradation (e.g. deforestation).
Project Design and Implementation
General Principles
Ensure that shelters are ‘built back better’ with, for example, Disaster Risk Reduction
(DRR) considerations taken into account, such as resistance to earthquakes or floods
as appropriate.
Promote and implement structural improvement to reduce vulnerability in damaged
buildings.
Involve women, children, youth and vulnerable groups (disabled, elderly etc.) in the
design and layout of shelter settlements and facilities to ensure they are safe and
accessible for all.
Ensure structures are built in safe areas e.g. not areas at high risk of disasters, insecurity
etc.
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65
Locally appropriate design. Consistency with existing local house sizes and styles may
also be important in order to avoid creating tensions within or between communities.
In addition, local designs are often more suited to deal with local environment, and
thus more resilient to local risks than ‘modern’ styles.
Ensure other basic survival needs are met (e.g. food), otherwise grants intended for
shelter will rationally be diverted to meet urgent survival needs, and shelter impacts
will be undermined.
Consider other needs linked to occupying the shelter e.g. beds, basic household items,
cooking needs etc. Where timber is in short supply (e.g. due to construction needs) it
may be appropriate to consider providing fuel-efficient stoves to reduce pressures on
timber resources.
Ensure access to adequate water and sanitation provision.
Ensure sustainable material sourcing to protect the local environment and maintain
disaster resilience e.g. avoid deforestation which can cause landslide risks and
undermine sustainability.
Select and design sites to provide safe access to communal services (e.g. health
facilities, water points, markets, schools, latrines etc.).
Where possible, plan settlements to take into account access to livelihood activities.
It is advisable for affected households to sign an agreement before construction work
starts, to ensure agreement with proposals of the technical adviser, and compliance
with standards.
Where multiple organizations are working on shelter interventions in the area, ensuring
that all organizations support the construction of comparable shelters and/or provide
comparable levels of CCTs can reduce conflict and tensions within and between
communities.
Don’t forget other resources required e.g. water for mud bricks or mud render, and who
owns or controls access to these inputs. Negotiating access can cause considerable
delays and may fail.
Instead of dealing with each household separately, some projects use “cooperation teams”
comprised of a small group of households (e.g. five). This approach can help to support
vulnerable households, harmonize construction speeds and improve community cohesion.
None of the group members would receive their next payment until all of the households in
the group had reached the required stage of construction. This encourages households to
cooperate, and to help the most vulnerable.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Shelter Case Study 2:
Cash Cards for Shelter Assistance: Chile Earthquake 2010
Following an earthquake in Chile in February 2010, two forms of assistance were provided:
Phase 1: a non-food item distribution to 10,000 households immediately following the
earthquake;
Phase 2: plastic cards with magnetic strips were given to earthquake affected households.
The cash card scheme allowed for the improvement of housing through the purchase of
different household items, as well as material for the reconstruction of damaged homes.
The monetary value of the card was equivalent to $375 USD. Staff from the participating
suppliers and beneficiaries were trained on the use of the cards. The cards were valid for 30
days from manufacture and redeemable in 40 pre-designated hardware stores. Staff from
the hardware stores also travelled to communities with product catalogues, which assisted
affected households who had limited access to transportation.
A call centre was available to answer questions on the use of the card, and also enabled
beneficiaries to verify the amount of funds remaining on their card along with the location
of participating stores.
Technical solutions
The expiration date of the card was recorded in the magnetic strip by the manufacturer,
and also printed on each card. Once the users received their cards, most had one month to
use it. Due to the time needed to distribute the cards, some beneficiaries had less time to
purchase material. Partial purchases were allowed, meaning they could buy several times
during the month in smaller volumes, or the funds on the card could be used to make a
single bulk purchase for the total value of the card.
During an interim project review, approximately 80% of respondents stated that they had
the knowledge to make their own repairs with the materials purchased with the card, 17%
paid for someone else to do them, while 4% stated that they did not have the knowledge
and would have liked to have been trained in how to make the repairs themselves. At a later
stage, initial home repair guidelines were delivered at the same time as the cards.
The prices of a basket of selected materials at various hardware stores should have been
monitored over the course of the project. At the start, a baseline price survey should have
been conducted to check that the project had not led to price inflation. However in a midterm evaluation, 80% of the targeted families found the prices in the stores acceptable, and
there was little evidence of price escalation due to the project.
Adeso Sector-based Guidelines for Cash Transfer Programming
67
Strengths
The project was well received by
Weaknesses
Selection of beneficiaries was not as
beneficiaries, giving them flexibility to
clear as it should have been. Many felt
spend resources as they saw fit.
that some who received assistance
The project team invested time to explain
didn’t suffer major damage to their
the project to beneficiaries. Suppliers
homes whilst other excluded families
were also able to explain the process
should have received assistance. This led
well to beneficiaries.
to some jealousy and resentment from
Community members were encouraged
those who did not receive cards.
to group their purchases together to
More time should be given for the
receive free or reduced price delivery of
use of the card or it should have been
their materials from the merchants.
distributed earlier than it was.
The project did not provide technical
support on safer and more earthquake
resistant construction. It did not build on
the experiences of recent programs in
neighboring Peru.
Source: Shelter Projects 2010. Chile - 2010 - Earthquake. IFRC, UN-HABITAT and UNHCR.
Available at: ShelterCaseStudies.org.
Potential Issues
Three key concerns of agencies when considering cash for shelter projects are:
Quality assurance.
Risk of diversion of funds (e.g. by errors of inclusion, bribery, elite capture etc.).
Achieving large scale responses.
Concerns that beneficiaries may build poor quality shelters can be addressed by:
Inclusion of training/provision of advice – perhaps through a technical resource centre
or ‘master’ builders who provide direct guidance to program participants.
Providing technical support throughout the construction process.
Involving the shelter team and/or technical consultant in regularly checking the quality
of the shelter during construction.
Establishment of shelter committees can facilitate more effective dialogue with communities.
They offer a focal point for verification of households and can provide feedback between
agencies and the community. Some agencies experienced issues of households being
asked to pay money to cover the costs of shelter committee members or to build public
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Adeso Sector-based Guidelines for Cash Transfer Programming
infrastructure. Whether it is regarded as fraud or legitimate cost covering, the pressure on
households to make payments may be reduced if committee members are paid a small per
diem to cover their costs such as fuel for travelling to meetings.
Similarly, if community leaders are expected to spend a significant amount of time monitoring
whether cash grants are being used for intended purposes, some level of compensation
may be necessary.
Targeting
Because of the larger value of the disbursements involved in shelter projects (whether cash,
voucher or in-kind), it is even more important than usual to ensure accuracy of targeting.
Attempts by individuals or local elites to manipulate the beneficiary lists may be an increased
risk, making openness and transparency of targeting procedures crucial. Beneficiaries
should be clearly informed that they must not make any payments to anyone linked to
achieving inclusion on the list. Targeting criteria must be:
Easily understood by the whole community (including those excluded.)
Easily verified using objective criteria (not subjective judgments or opinions).
Widely publicized and verified within the community.
Subject to an accessible appeals/complaints procedure which is confidential and
independent.
Examples of targeting criteria which have been used in shelter projects include:
Composition of the household, including vulnerability indicators.
Number of demolished homes within the community (community level targeting).
Objective assessment of levels of repair needed etc.
Owner/renter of the house and the house is the main domicile of the occupant.
Damages to the shelter were due to a particular crisis event (e.g. the hurricane/
landslide).
Damages to the structure must meet established criteria e.g. for “Destroyed,” “Major” or
“Minor”.
The owner has plans and has begun or would begin repairs if they had access to
materials.
Occupant has the capacity to repair the house themselves or access to other sources
of labor. (community, family, neighbors).
Household has insufficient resources to rebuild without help, and is not receiving
assistance from the government or any other organization in relation to shelter repair.
Make selection criteria clear to partners and the community. Survey teams may be asked to
reassess housing damage if an appeal is received on the initial assessment. Appeals will be
fewer and their resolution easier if damage classification and targeting criteria are simple,
easy to use and transparent.
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69
Shelter Case Study 3:
“The
Cash for Shelter Assistance: Afghanistan 2012
This project addressed the poor living conditions of recent
refugee-returnees, IDPs and host families. Although the
organization had been building shelters in Afghanistan
for a number of years, this had previously involved direct
provision of construction materials. A pilot cash based
project took place in 2011, with a larger second phase
launched in 2012.
Community
Program
(CDP)
Driven
method
allowed me to purchase
the material for my shelter
according to my own choice,
and design of my shelter unit
was finalized in consultation
with my family members”
Abdullah, shelter beneficiary
in PD#13 Gozar 21
Households were provided with cash transfers in phases to allow them to build a one or
two room shelter with sanitation facilities. Cash grants were made in four installments
to purchase shelter materials, and transferred to individual householders in envelopes.
To ensure community networks and support vulnerable beneficiaries (especially women
and disabled people), the project established beneficiary groups of four to five members.
None of the group received their next grant installment until all of the group members had
reached the agreed stage of construction. This condition forced the group members to help
each other and work together.
Technical issues
Instead of providing specific designs, the project provided technical advice to address the
disaster risks. Model drawing designs were also made available to the beneficiaries by the
field teams. The decision to give homeowners flexibility in what they could build was based
on learning from previous projects where only one shelter design was allowed. In Kabul,
land and plot sizes are not uniform, and flexibility allowed houses to be adapted to the
space available.
The cash-based approach allowed team members to spend more time with households,
which meant they were able to explain seismic mitigation measures better than in previous
years.
Logistics
Timber bracing for shelters, tool kits and hygiene kits were procured by the project and
delivered to the beneficiaries. The rest of the materials such as lintels, roofing materials,
doors, windows and latrine slabs were procured by the households themselves. In each
shelter unit construction there was around 30 to 35% contribution from the beneficiaries.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Project Effectiveness
The pilot project was implemented by a team of six people with mixed skills (engineers,
mobilizers, data collection). In previous years, this team had built 100 houses per year with
the organization managing all procurement and logistics. In this project, the same team
built 295 houses in less than one year. The project has since been expanded to other parts
of Afghanistan.
Strengths
Weaknesses
The beneficiaries were able to take
control of the construction process, and
adapt the design of the shelters to their
own needs.
Difficulties in achieving a gender balance
among beneficiaries.
Challenges
identifying
the
most
vulnerable.
The use of co-operation groups of
Did not address wider community
five beneficiary households together
planning issues, in terms of community
was promoted in order to control
sanitation and drainage, or community-
construction
level DRR.
speed,
and
promote
community cohesion.
Some
construction
techniques
The field teams were able to spend more
which returnees learned working on
time discussing DRR measures with the
construction sites in Iran were not
beneficiaries for each individualized
earthquake resistant in the Afghan
shelter.
context,
or
with
locally
available
materials.
Source: ShelterCaseStudies.org. Shelter Projects 2011-2012. Afghanistan - 2012 - Conflict
Returns
Technical Support for Construction
Appropriate technical support and sensitization on quality/safety standards is essential, and
should always accompany cash grants for shelter construction. Some tasks may be beyond
the skills of recipients, and at key stages they may require assistance from skilled tradesmen,
such as carpenters. This has to be built into the program design.
By repairing or building shelters, the agency will, in effect, be seen as guaranteeing the safety
of the finished structure in the eyes of the occupants and the community. It is therefore
essential that adequate technical support and quality controls are in place to ensure safety
requirements are met. In Pakistan after the 2005 earthquake, technical resource centers
were established to fulfill this role.
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71
Technical control becomes difficult with diverse buildings. When dealing with the
construction of large numbers of shelters, the difficulties of ensuring technical compliance
with standards will be onerous if all households adopt very different designs. For this reason,
it is advisable to limit the number range of basic designs, possibly to around four variants.
It is then possible to provide training on these designs, reinforced by construction design
information posted in communities - for example pictorial representations on posters.
Families can still be free to make non-structural adaptations to basic designs, as long as
these do not affect the strength or resilience of the structure.
At a minimum, ensure recipients of cash for shelter construction receive adequate skills
training to enable them to effectively supervise the quality of work carried out by any
construction workers they employ. If they are going to carry out much of the construction
work themselves, then a higher level of training and skills development is likely to be required.
Properly designed cash for shelter projects may have the added benefit of developing the
construction skills base in the local/regional economy.
Technical training focusing on new shelter construction can teach households and
communities new and safer construction methods as part of the process to “build back
better”. This will ensure that new permanent shelters are less vulnerable than previous
structures, and of a higher quality. If households are repairing old homes, there may be a
tendency for them to continue using old methods, and guidance will be needed on how
structures can be strengthened and made more disaster resistant. It is often easier and
better to build new shelters following safety guidelines than to try to patch up pre-existing
sub-standard shelters with limited funds. This is something that agencies need to consider
when planning and budgeting for cash for shelter projects.
Where a local construction consultant is recruited to provide technical support and postdistribution monitoring, this can add significant value in ensuring that houses are safe and
built according to the local and national standards. Shelters should comply with Sphere
Guidelines, local regulations, building codes, and agencies’ own standards.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Complementary Programs
Community Grants are sometimes used to accompany shelter grants. These can help foster
cohesion in the community whilst relieving tensions between host communities and the
displaced e.g. by helping to relieve pressures on services. Cash for Work could also be used to
undertake community-based work that benefits individual members as well as the community
as a whole. These activities may range from removing debris from public facilities, road clearing,
drainage cleaning, erecting temporary bridges, helping vulnerable individuals to repair their
shelters etc.
After the Haiti earthquake in 2010, IFRC set up one of the few cash programs combining
shelter and livelihoods. The program provided people with multiple choices, with the objective
of supporting households in returning to their places of origin or finding a shelter solution
outside of the camp. It consisted of a menu of options that people can select from, ranging
from a conditional grant for rent to an unconditional grant for setting up small businesses and
restarting livelihoods. Due to the complexity and flexibility of the program, monitoring costs
were high (more than 60% of project costs). Adeso Sector-based Guidelines for Cash Transfer Programming
73
Setting the Payment Rate
Setting the size of cash grants to support shelter repair or reconstruction requires a good
understanding of the costs involved in carrying out the building works to the required
standard. In addition, it is necessary to decide whether the grant should cover the whole
amount, or whether the occupant should also make a contribution. The occupant’s
contribution may be in the form of either cash, materials or labor. A risk in requiring a
financial contribution from households is that this may disadvantage or exclude the most
vulnerable households. Similarly, labor contributions required from households should
take account of the needs of vulnerable households lacking able-bodied adult members,
perhaps by providing these households with an additional sum to cover costs of employing
additional assistance with labor requirements.
If a simple flat-rate grant is provided for all people whose houses are affected, then people
whose houses are only slightly damaged would receive the same amount as those whose
homes had suffered much greater damage. However, calculating the cost of repairs on a
case-by-case basis is difficult and time consuming. It is therefore likely to be more efficient
to allocate structures according to the level of damage they have incurred, and provide a
limited number of ‘bands’ of payment rates.
Inflation in the price of building materials may be a risk in areas where large numbers of
houses require repair. This could occur either independently of the CCT program - due
to a general increase in demand or disruption of supplies - or may be attributable to the
increased demand generated by the cash transfers. In either case, prices and availability of
goods needs to be closely monitored, as inflation will erode the value of cash grants, and
unless adjustments are made it may lead to the grant being insufficient to complete the
required works.
Key principles when setting the value for shelter projects include:
Relevance. The amount should be linked to the cost of meeting the identified needs.
Harmonization. Payment rates should be coordinated with other agencies involved in
similar interventions in the area, to avoid large discrepancies in payment rates between
organizations.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Key questions which need to be asked when setting the transfer value include:
What goods and services do households need to enable them to meet the program
objectives?
How much do the required goods and services cost locally?
What can households provide for themselves or from other sources (e.g. are salvaged
materials available?)?
Are there additional costs that need to be taken into account (e.g. tools, skilled labor,
transport of materials)?.
Shelter Case Study 4:
Categorising Damage Caused to Houses from Cyclone Sidr
The initial assessments had indicated that Cyclone Sidr had affected more than 7,000
homes in the target communities, to varying degrees. The first task was to conduct an indepth assessment, to identify affected homes and record the extent of the damage they had
sustained. This identified which households would be eligible for shelter assistance. At the
same time, other team members carried out market surveys, to determine the prices and
availability of local building materials.
Following this door-to-door verification, the information gathered was analysed and
classified under the following seven levels of damage:
Categories 1 and 2: totally destroyed homes – households received a core shelter
plus USD $72
Categories 3 and 4: severely damaged but repairable homes – households received
USD $144
Categories 5 and 6: partially damaged homes – households received USD $72
Category 7: only minor cosmetic and non-structural damage – not eligible for
shelter assistance.
This defined the three levels of shelter assistance needed and the value of the cash grants
required.
Source: “Rebuilding lives with shelter grants”. IFRC Case Study of Cyclone Sidr, Bangladesh.
www.ifrc.org
Adeso Sector-based Guidelines for Cash Transfer Programming
75
Process for CTP for Shelter Repair or Rebuilding After a Natural Disaster
Assess
Assess damage levels of houses and categorise according to the
Damage &
level of repair required.
HH Needs
Ensure a technical consultant is involved in the damage
assessment.
Ensure comprehensive documentation of damage to avoid
disputes over levels of payment. Take detailed photos of
damaged areas during initial assessment and after repair.
Identify other needs the households have that are currently
unmet.
Identify
Fully document reasons for any houses which are assessed not
Proposed
being included (for appeals reasons).
Solutions
Verify whether the house can be repaired to a safe and acceptable
standard.
Technical solutions proposed by the consultant should be fully
documented.
Check land use rights and agree the proposed solutions for repair
of houses with the occupant /owner.
Consult with beneficiaries and communities on proposed
solutions. Consider setting up shelter committee(s).
Are basic survival needs being met? If not, shelter grants are likely
to be diverted for food etc. Consider adding measures to meet
basic needs e.g. UCT for basic needs, plus CCT for shelter.
Materials
Assessment
Using the technical report on damage, develop a bill of quantities
to assess the materials needed.
Use the bill of quantities to estimate the cost of repairs /rebuilding
according to level of damage.
Ensure materials are available locally to sustainably meet demand
at a reasonable cost e.g. without environmental damage such as
deforestation.
What other goods / services are needed to complete the work
(e.g. tradesmen, tools, transport for goods).
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Adeso Sector-based Guidelines for Cash Transfer Programming
Calculate
Using the estimated cost of the repairs, set the cash transfer
Transfer
level for each category of damage (from minor repair to total
destruction).
Don’t forget other costs e.g. tools, nails, transport of materials,
access to water for cement/bricks etc.
Decide what payments need to be added for labour needs employing skillled labour and own labour.
Payments
Regime
Determine phasing and conditions on payments - stages to be
completed before each payment.
Sensitize recipients on reasons for payment levels, conditions for
payments, phasing, payment method.
Ensure recipients know the structural and quality requirements
the structure needs to comply with in materials purchases and
construction in order to receive payments.
Are recipients to work in groups or individually?
Technical
Support
Provide comprehensive technical support throughout the
construction to enable recipients to ‘build back better’ and meet
required safety and structural specifications.
Provide training to recipients to enable them to build or to
oversee the work of tradesmen/contractor.s
For rebuilds, use a limited number of design styles that recipients
can choose from and adapt in order to ease burdens on technical
support staff and help ensure structures meet the required
standards.
Monitor
Compliance
Closely monitor compliance with progess and technical standards
at all stages of the construction.
Ensure appropriate technical expertise is available to ensure
structural and safety standards are met.
Provide support and mentoring to any recipients experiencing
difficulty in meeting standards.
Ensure timely payments of transfers to avoid delaying progress
with construction.
If payments are withheld ensure the recipient understands
the reason and is assisted to rectify the situation e.g. for noncompliance of not meeting standards.
Adeso Sector-based Guidelines for Cash Transfer Programming
77
Materials
Using the technical report on damage, develop a bill of quantities
Assessment
to assess the materials needed.
Use the bill of quantities to estimate the cost of repairs /rebuilding
according to level of damage.
Ensure materials are available locally to sustainably meet demand
at a reasonable cost e.g. without environmental damage such as
deforestation.
What other goods / services are needed to complete the work
(e.g. tradesmen, tools, transport for goods).
Common mistakes made when setting the value of the cash transfer include:
Failing to base the value of the grant on the costs of meeting the project objectives.
Basing the value on what it would cost to provide the goods in-kind.
Not considering what the households can provide for themselves.
Not allowing for price changes.
Not including transport costs (or other costs, such as water for construction).
Assessing prices and costs in the wrong location or wrong market.
If payment rates are set too low, and do not enable recipients to meet the full costs of
rebuilding, a significant number of households may chose not to participate, and to remain
in damaged or unsafe structures, or they may build poor quality shelters that do not meet
minimum standards.
Staged payments. Due to the relatively large sums involved, cash grants for shelter are
usually made in staged payments, dependent on the completion of agreed elements of the
construction process.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Monitoring and Evaluation
Detailed guidance on monitoring and evaluation of cash for shelter projects is provided
in the Practical Tools Guide. However, key considerations in monitoring and evaluation
include:
Prices and availability of goods needs to be closely monitored, as inflation could erode
the value of cash grants, and may lead to the grant being insufficient to complete the
required works.
Close monitoring of structural safety standards and risk proofing of structures against
future repeat disasters (earthquakes etc.) is essential, as in facilitating construction the
agency is likely to be seen as implicitly taking responsibility for the safety of the final
structure. It should be noted that the problem of how to ensure quality standards are
met exists in all shelter projects, and is not limited to those using cash-based approaches.
Further Reading
Adeso, 2012. A Practical Guide to Cash-Based Responses
A Cash and Shelter training module has been developed by the Cash Learning Partnership
(CALP), the IFRC Shelter Department, and Oxfam GB. http://www.interaction.org/document/
cash-shelter-how-cash-transfers-can-be-used-humanitarian-shelter-responses
Examples of Shelter case Studies: www.ShelterCaseStudies.org
Sphere 2011 standards for shelter and settlement projects (strategic planning, settlement
planning, construction, environmental impact) are available at http://www.spherehandbook.
org/en/1-shelter-and-settlement/
ShelterCluster.org 2010. Shelter After Disaster Guidelines 2010 - Available at: http://www.
sheltercasestudies.org/files/SC-OCHA-DfID-shelter-after-disaster-2010.pdf
IFRC, 2012. Assisting Host Families and Communities After Crises and Natural Disaster - A
Step-by-Step Guide. International Federation of Red Cross and Red Crescent Societies.
Farrington and R. Slater, 2009. Lump Sum Cash Transfers in Developmental and PostEmergency Contexts: How well have they Performed? Overseas Development Institute
(ODI), Cash Transfer Series, July 2009
IFRC / ICRC, 2011. Guidelines for Cash Transfer Programming
Various resources on the Cash Learning Partnership website at: www.cashlearning.org
Adeso Sector-based Guidelines for Cash Transfer Programming
79
Refugees &
Displaced Persons
Photo Credit: Tugela Ridley (© Adeso)
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Adeso Sector-based Guidelines for Cash Transfer Programming
Refugees & Displaced Populations
Overview of C&V for Refugee and Displacement Situations
Cash transfers are well established as a tool to support return and reintegration of refugees
and IDPs. Most experience of the use of large scale cash transfers in this context has
occurred through large scale programs managed by the United Nations High Commissioner
for Refugees (UNHCR). For example, UNHCR has employed cash transfers as part of its
repatriation and resettlement packages for refugees returning to Afghanistan since the early
1990s. In Afghanistan, three million people were assisted by UNHCR between 2002 and
2005, using repatriation grants. However, humanitarian NGOs have also provided cash and
voucher based assistance to refugees and IDPs in a range of contexts.
Why Give Cash and Vouchers In Refugee and Displacement Situations?
Cash may be the appropriate response option for refugees and IDPs for a number of reasons:
The individual needs of displaced populations vary widely. Cash is well suited to
meeting diverse needs, and is now widely used as a replacement for in-kind assistance
to displaced households, enabling families to decide which goods or services best
meet their needs.
As displaced persons often seek to move to safer areas, this increases the likelihood
that markets will be functioning comparatively well in these areas.
Cash grants have been shown to facilitate accelerated repatriation (Liberia, Afghanistan
and Burundi). They can also effectively meet basic needs and help to re-establish
livelihoods of displaced or returning populations.
Displacement often leads to key productive assets (e.g. land, machinery) being left
behind, undermining income from people’s own production and making them more
dependent on market purchases and aid. Cash can help to replace lost income and
restore assets.
Increasing their purchasing power stimulates local markets and creates positive
interactions between the displaced and host communities.
Cash is a flexible and easily movable asset, making it easier to transport if compelled to
relocate in a crisis, instead of having to physical assets, often at a fraction of their value.
Cash transfers allow refugees to be treated more like other members of communities,
reducing the risk of stigmatization or discrimination.
Cash can play an important role in ‘normalizing’ a refugee’s life in their place of exile
through economic empowerment and facilitating access to financial services such as
banking.
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81
In repatriation, distribution of cash over wide geographical areas can be logistically
easier and less costly than transport and delivery of in-kind goods. Money transfer may
be made through existing networks of money traders, micro-finance institutes, banks
or mobile phone transfers.
Cash transfers can improve relationships between displaced populations and host
communities, for example by improving the status of the displaced, reducing begging
and theft, and by enabling the displaced to participate in community activities
and support structures such giving small amounts of cash for funerals, weddings,
celebrations, etc.
In Burundi, the use of cash transfers by UNHCR was a response to the realization that
returnees were selling parts of non-food item kits to meet cash and basic needs, extend
their stay with host families, buy or rent land and purchase agricultural inputs .
How Can Cash and Vouchers Be Used in Refugee and Displacement Situations?
Cash grants have been used in a range of displacement and voluntary repatriation contexts.
Cash can be used either with or instead of in-kind assistance to provide for a range of
needs encountered by displaced families. For example, it can replace in-kind provision of
food, shelter materials, non-food items and WASH items. It can also be used to establish or
restore livelihood activities.
In displacement situations cash transfers are often used to enable people to:
a)
b)
c)
Meet their basic needs whilst in exile.
Establish temporary livelihoods until return is possible.
Replace household or productive assets lost when families fled.
d) Secure temporary accommodation during displacement (rental payments or
construction of temporary shelters). Cash transfers can provide an alternative to campbased assistance, by enabling displaced families to pay rent to host families, or secure
commercially rented accommodation.
Where it is clear that households will not be able to return to their place of origin, cash
transfers can be used for resettlement and to assist integration into host communities.
In voluntary repatriation, cash transfers have usually been provided to meet one or more of
the following purposes:
a. To replace provision of organized transportation. “Transport grants” usually vary
according to the distance from the refugee-hosting region to the place of origin/final
destination.
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Adeso Sector-based Guidelines for Cash Transfer Programming
b. To replace all or part of former in-kind repatriation assistance packages in order to
reduce logistical costs and better meet the needs of returnees.
c. To support initial “reintegration”. Reintegration grants can be used to cover immediate
needs upon arrival, including rebuilding livelihoods, small business start-up and incomegenerating activities. Cash grants may also be used to rebuild or repair housing, or to
purchase or rent plots of land (e.g. in Burundi), as reoccupying former land or houses
is a major issue in many post-conflict settings. Cash maximizes the options available
to returnees. In Cambodia, cash grants were reported to have enabled returnees to
choose their area of return, easing the pressure on individual communities.
The needs of displaced populations cut across all sectors, including (but not limited to)
those covered in other sections of these guidelines. This section will therefore focus solely
on the following objectives, specific to displaced populations:
Resettlement.
Support for return and reintegration (within or between countries).
Support for accommodation by host families.
Support for host communities to assist in infrastructure provision/facilitate integration/
reduce tensions and perceptions of inequitable treatment between refugees and host
communities.
Most examples of the provision of cash transfers to displaced populations have, to date,
been relatively short-term initiatives, with long-term forms of support relying on in-kind
provision which may be maintained over many years. More recently, UNHCR have been
exploring options for converting some of its support in long-term situations to cash based
approaches.
Unconditional Cash Transfers (UCTs)
Unconditional Cash Transfers have most commonly been used during displacement, since
most grants to returnees are conditioned on their return to the country or location of origin.
UCTs in displacement are usually intended to enable displaced households to meet their
basic needs, and to replace assets lost when the family fled. In some cases UCTs may be
used for the purchase of livelihood assets, such as agricultural tools and seeds. However,
livelihood activities are often constrained by lack of access to land or restrictions on
refugees’ ability to legally work or trade within the host country.
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83
In South Kivu in DRC, unconditional cash grants have been used in conjunction with legal
assistance to IDPs to secure temporary land leases. An Unconditional Cash Transfer was
provided to holders of temporary land leases to enable IDPs to utilize the land, for example
by purchasing agricultural inputs and tools to enable them to grow food crops to feed their
households.
Examples of Using Cash and/or Vouchers in the Refugee and Displacement Sectors
Interventions Directly Targeting
Beneficiaries
Supporting
Displaced
Indirect Interventions
Populations Interventions
improving
access
to
and Assistance to Repatriation and/or education through targeting other points
Reintegration and/or Resettlement through in the supply chain.
provision of cash or vouchers.
Transportation grants: vouchers or grants Payments to host families to renovate/
to cover transport costs in repatriation/ extend shelters to accommodate refugees.
resettlement.
Direct payment of rent to host families.
Resettlement
grants.
These
are
CCTs
conditioned upon return to the place or Grants to host communities to reflect
country of origin. They may be intended to pressures on services etc.
cover some or all of the following needs:
Cash for Work in host areas to improve
Basic needs (food, medical, educational community services or assets.
etc.) for a fixed period after arrival (e.g.
three months).
Poorer members of host communities
Shelter construction/rental.
Purchase
of
NFIs/household
are often included in support programs
goods (including cash transfer programs, shelter
required for resettlement.
programs etc.) to reduce inter-community
Securing access to land (purchase or tensions.
rental).
Re-establishing livelihoods, such as
purchase of tools and agricultural inputs.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Cash grants to facilitate small-scale Community-based cash grants: Cash grants
voluntary return prior to the main phase to support host community development
of a repatriation program, or late small- or coexistence projects.
scale returns after the main phase is over.
Cash grants during displacement to assist
with:
Basic food and NFI needs.
Educational
support
grants
(fees,
materials).
Livelihoods/small business start-up.
Rental of land and/or purchase of
agricultural tools and inputs.
“Winterization”/rain-proofing of shelters,
warm clothes.
Shelter construction/repair.
Accommodation rental payments.
Renewal
of
entry
permits
(Syrian
refugees in Jordan).
Cash for Work to provide income and:
Improve camp or community assets.
Improve
hygiene
conditions
(e.g.
clearing litter, constructing latrines,
clearing rainwater culverts).
Shelter construction.
Conditional Cash Transfers/Restricted Cash Transfers
The most common uses of Conditional Cash Transfers in displacement contexts are:
Conditional grants for basic food and non-food needs during displacement.
Support for shelter during displacement and upon return/resettlement (see also the
shelter section of these guidelines).
Repatriation/resettlement grants once return is safe and desired by affected households.
However, it is also possible to condition cash transfers on the use of public services. For
example, UNHCR has conditioned cash transfers on use of health and education services in
camps and other displacement situations.
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85
Restricted cash grants place restrictions on what the cash can be used for, such as paying
for a particular commodity or range of commodities e.g. to pay rent to host families.
Cash for Work
Cash for Work programs can help support refugees or IDPs on return to their communities
by providing short-term employment and income support during the immediate postreturn period.
Cash for Work projects are well suited to unskilled manual tasks such as clearing debris and
reconstructing infrastructure. These activities can help to rebuild communities affected by
debris or damaged infrastructure caused by a sudden-onset disaster or prolonged conflict.
Cash for Work also provides an injection of cash that can help rebuild or revitalize local
markets.
Cash for Work projects are most successful when they are community led. CfW should be
implemented in partnership with community members, as they are best able to identify
the work needed, and to ensure the long-term maintenance of community assets and
infrastructure. They are also best informed on community interactions, and the most able
to assess the risks both of conflict among potential participants and of cash being diverted
to arms purchase or conflict-related activities.
Displacement Case Study 1:
Cash for Work Accelerates the Returnee Process
Cash for Work programs following the 2004 tsunami offered jobs in devastated communities
before local businesses had recovered enough to provide employment. Participants were
able to work rebuilding their own communities and were involved in a variety of projects,
including: removing and burying the deceased; cleaning and repairing drains; cleaning
water systems; cleaning and rebuilding latrines and other public facilities; reconstructing
bridges; and cleaning, rehabilitating or constructing houses and shelters.
Clearing agricultural land and roads allowed important industries to resume more quickly.
Building temporary or semi-permanent shelters allowed more people to return to affected
areas.
Because cash programs can be implemented quickly, the implementing agency was able to
start CfW programming within two weeks of the disaster. By quickly providing incentives for
people to return home and work on recovery efforts, CfW minimized the time participants
spent as IDPs.
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Adeso Sector-based Guidelines for Cash Transfer Programming
The cash payments, which were initially set above pre-disaster rates, encouraged inland
traders unaffected by the disaster to resume trade in the CfW areas. 91% of participants in
these CfW operations reported that CfW facilitated their return home.
Source: Women’s Refugee Council, 2009
Vouchers
Value-denominated voucher programs (particularly voucher fairs) are frequently used in
conflict situations to minimize risk of diversion and maximize security of beneficiaries and
program staff by removing the need for handling large amounts of cash. Payments to traders
can be made directly into their bank accounts on redemption of the vouchers.
The diversity of potential uses of cash-based programming in displacement situations
is illustrated by the following table showing the range of uses adopted within UNHCR
operations. However, these guidelines will focus on those aspects which are specific to
displacement and repatriation/resettlement situations, such as repatriation grants.
Objective
Country examples
Cash grants to provide for basic needs for the urban displaced, Egypt, Ethiopia
particularly housing costs.
Cash grants to provide for basic needs of vulnerable groups in Chad
a camp.
Seasonal cash grants to cover increased expenditure during Jordan, Afghanistan
winter (e.g. clothes, utilities).
Cash grants for host communities to renovate homes to host Lebanon
displaced people.
Food vouchers to provide access to basic foods.
Syria
Milling vouchers to cover for milling cost of food aid cereal.
Sudan
Fresh food vouchers to diversify diet as a complement to general Kenya
food distribution.
Vouchers to provide access to non-food items in supermarkets. Ecuador
Vouchers to provide access to core relief items in a fair.
DRC
Health insurance to provide access to health care.
Iran
Shelter grants for returnees.
Sri Lanka
Cash grants to facilitate the socio-economic reintegration of Mozambique,
returnees.
Honduras, Afghanistan
Source: UNHCR, 2012. An Introduction to Cash-Based Interventions in UNHCR Operations.
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87
Combined Approaches
Cash based interventions can be used on their own, or in combination with in-kind
assistance (e.g. a milling voucher with food rations; seeds with a cash grant for tools; shelter
materials with cash for skilled labor). In recently established camp settings where market
opportunities may be limited, a combination of in-kind and cash-based assistance may be
the most suitable response, but as markets increasingly become established within these
locations, a shift towards cash-based approaches may be implemented. In urban contexts
where there is good availability of markets and financial cash delivery services, it may be
more effective to channel assistance through cash based approaches.
When shifting from prolonged in-kind assistance to cash based assistance, a gradual or
phased transition is recommended, especially where in-kind aid supplies have become an
integral part of local market supply chains e.g. where food from food aid distributions is a
key source of food in the market. Introducing cash based assistance too rapidly, or at the
wrong time (e.g. peak of the lean season) may have negative impacts in terms of increases
in prices and reduction in local market supplies.
Assessing Appropriateness
Preconditions for Using Cash and Vouchers for Displacement and Repatriation
Requirements before cash transfers can be considered in displacement situations include:
Local markets remain functioning and accessible, are safe for the displaced families
to use, and their links to source markets has not been disrupted by the cause of the
displacement.
Refugees need have sufficient freedom of movement to enable them to access
markets.
There needs to be a safe and secure way of getting the money to the refugees/IDPs.
The government should agree to cash transfers, particularly in the case of refugees,
whose situation may be different from IDPs as they are not in their own country.
Additional requirements for repatriation or resettlement grants:
Places of origin/resettlement must provide a safe and secure environment for return.
In particular, the core reason for displacement (e.g. conflict, chronic natural disasters
such as prolonged drought) must have been sufficiently resolved to make return safe,
feasible and desired by displaced families.
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Adeso Sector-based Guidelines for Cash Transfer Programming
Refugees must be voluntarily willing to return to their country/village of origin.
Conditions of return comply with international regulations and treaties on repatriation
of refugees.
Availability of basic resources/services in resettlement areas (water, education, health
etc.).
Program Design and Implementation
Design of resettlement grants should be based on a detailed analysis of what assistance
is required to facilitate a smooth return and reintegration process, taking into account the
refugees’ particular needs in the specific situation being considered. Standardized return
packages may not address real needs and should usually be avoided.
Contingency Planning and Emergency Preparedness
In displacement-prone areas where cash based interventions may need to be set up
quickly, they should be systematically incorporated into the agency’s contingency planning
and emergency preparedness through pre-disaster market mapping, or pre-negotiating
partnership arrangements with governments, partner agencies, NGOs and the private
sector (e.g. potential cash delivery partners).
Implementation process
Cash transfers in repatriation/resettlement programs usually involve the following key steps:
De-registration. Displaced families will usually be required to de-register from camp or
refugee databases in order to receive a document which can be used as a “voucher” to
receive the cash grant. In Afghanistan (1990-93), refugees had to hand in their passbooks
and ration cards in return for their Voluntary Repatriation Form and “encashment sheet”,
making them eligible for a cash grant. In some cases refugees may have failed to register
in the host country due to fear of persecution on return or of relatives remaining in the
country of origin e.g. some Syrian refugees in Jordan.
Verification to minimize ‘recycling’. The main challenge encountered in operation of
repatriation and resettlement grants is “recycling” i.e. when returnees fail to actually
return and attempt to make repeat claims for repatriation/resettlement grants. This can be
addressed using verification against a registration database, cross-checking of applications
or the use of biometrics (e.g. iris scanning, fingerprinting) to identify recipients and reduce
recycling. Whilst the use of biometrics can significantly reduce recycling of grant applicants,
Adeso Sector-based Guidelines for Cash Transfer Programming
89
it involves data protection issues, particularly if government or other groups may demand
access to information on the database in, for example, a conflict situation.
The way in which the cash transfer is used can differ depending on where it is distributed. If
the grant is intended to assist the return of refugees, distribution points ought to be close to
the place of origin. This also helps to ensure that the return actually takes place, and allows
returns to be tracked.
General Principles
The voluntariness of repatriation, based on free and informed choice, has to be ensured.
Cash grants should not be used to stimulate repatriation where voluntariness is not assured.
Repatriation programs must ensure conditions are safe and suitable for return. Generally
the use of cash will not, on its own, cause pressure on refugees to return, particularly when
conditions in the country of origin are not conducive to voluntary repatriation. However,
refugees may feel pressured if the introduction of a grant is coupled with significant
reductions in the assistance provided in the country of exile, such as closing camp schools
and services, or political statements urging return. This may be particularly true if the
impression is given that cash grants will only be available for a limited period.
Displacement Case Study 2:
UNHCR’s Voluntary Repatriation Program to Afghanistan
Returnees under the UNHCR’s 2007 program of voluntary repatriation to Afghanistan from
Pakistan and Iran overwhelmingly identified money as their most important need on return. Over
80% of families ranked money in their top three needs. Returnees received an average of $100
USD per person, which comprised an $83 USD per person reintegration grant plus a transport
allowance which varied with distance travelled. Most felt that the size of the grant successfully
met their immediate cash needs. After money, returnees identified short-term assistance (water,
food, shelter and transportation) as the second most important need, and employment as the
third most important.
The cash grant successfully met the short-term needs of returnees, especially immediate cash
requirements and short-term water, food, shelter and transportation needs.
Returnees felt that cash was the most effective mechanism to meet their immediate and shortterm needs.
Returnees did not feel the cash grant was enough to be effective in meeting longer term needs
such as employment and housing rental. However, the cash transfer met the purpose intended
by UNHCR, which was to encourage return by addressing immediate and short-term needs.
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Adeso Sector-based Guidelines for Cash Transfer Programming
94% of returnees spent the money mainly on food and transport. Around a third used the money
to rehabilitate their houses. A few used the cash transfer to pay off debts and invest in businesses.
Transfers were spent rapidly - over half spent it within the first month, and 88% of families spent
the money within three months.
Some of those refugees who remained in exile in Pakistan did not consider $100 USD per person
an adequate sum to overcome the barriers to return, especially where families did not have
relatives, houses or land in Afghanistan.
Overall, the pattern of needs - indicating money was the most important need - expressed by
returning refugees confirms that cash transfers were an appropriate form of support.
Cash transfers made a very positive contribution in facilitating returns, by successfully meeting
immediate short-term needs. In many cases, cash transfers enabled refugees to return home.
However, the level of the transfer was not enough to make a significant contribution to
sustainable reintegration, as it was not designed to meet longer-term reintegration needs such
as employment or housing.
Source: Altai Consulting for UNHCR. 2009. UNHCR’s Voluntary Repatriation Program:
Evaluation of the Impact of the Cash Grant
What were your immediate needs upon your return to Afghanistan?
A. Most important need:
Money
66.2%
Short term assistance: water, food, shelter, transportation
15.2%
Provision of longer term housing
13.7%
Job placement
3.6%
None
0.8%
Education opportunities for children
0.2%
Other
0.2%
B. Second most important need:
Short term assistance: water, food, shelter, transportation
66.2%
rrovision of longer term housing
15.2%
Job placement
13.7%
Money
3.6%
None
0.8%
Education opportunities for children
0.2%
Advice/Counseling
0.2%
Training courses to acquire professional skills
Other
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91
C. Third most important need:
None
36.9%
Job placement
26.8%
Provision of longer term housing
9.9%
Education opportunities for children
9.8%
Money
7.9%
Short-term assistance: water, food, shelter, transportation
3.6%
Advice/counseling
3.0%
Training courses to acquire professional skills
1.7%
Other
0.3%
Potential Issues
Constraints on displaced populations which can hinder efforts to achieve self-sufficiency
can include restrictions on freedom of movement, discrimination, protection threats,
lack of social networks, lack of documentation and lack of appropriate skills .
Where displacement has resulted in the loss of support networks, family contacts, and
access to housing or land in the place of origin, these can be major barriers limiting
the uptake of repatriation grants. It may be necessary to increase the size of cash
grant required to overcome these obstacles to return and reintegration for affected
households.
Community Relationships
Unless appropriately designed, cash grants might negatively impact on relationships
between displaced and host communities, especially if there is a marked difference in living
conditions, quality of housing provided etc.
However, UNHCR in Burundi noted little evidence of increase in social tensions as a result
of the cash grant. A number of interviewees stated during an evaluation that the cash had
in fact had a positive impact, smoothing relations with host communities and enabling
returnees to avoid becoming a drain on the resources of host communities and host
families. In addition, using ‘discrete’ systems for the distribution of cash (e.g. micro-finance
organizations, mobile phone transfers etc.) and providing cash rather than in-kind assistance
can help to limit jealousy by making payment of the assistance largely invisible to nonbeneficiaries. Providing cash can also have positive benefits for host communities through
generating increased trade for merchants, and multiplier effects boosting local economies.
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Targeting
Targeting processes must consider whether to include protagonists from both sides of any
conflict, and whether to include host community members as well as displaced populations.
Composition of targeting can potentially exacerbate resentments or hostilities, or assist
in integration of displaced individuals with the host community. For example, working
alongside each other on Cash for Work projects can foster increased interaction, and lead
to improved relationships and development of friendships.
To avoid tensions within displaced communities, and between these groups and host
communities, when targeting cash transfers to specific groups the criteria defining each
group must be coherent and consistent throughout the operation, and the justification for
selection clearly spelled out. It is important not to appear to favor any ethnic or religious
group or one side of a conflict. Any perception of bias could compromise the program,
undermine community relationships or stimulate conflict.
Targeting processes may sometimes downplay the political status of displaced families,
targeting them due to general poverty levels and need for assistance. In order to avoid
creating tensions between displaced and host communities, programs therefore often
include vulnerable members of the host community as beneficiaries. Failing to do so may
generate feelings of resentment and inequitable treatment amongst the host community if
the program is seen as including displaced families who are viewed as ‘better off’ than poor
members of the host community who are excluded.
Cash Delivery Mechanisms and New Technologies
There is an increasing trend towards the use of new technologies and electronic payment
systems (e.g. pre-paid debit cards, smart cards, mobile money transfer) to achieve a more
efficient and reliable delivery of cash than provided by hand-to-hand cash distributions.
New technologies such as mobile phone transfers can offer significant advantages in
delivering cash over dispersed geographical areas as may occur with grants to returnees.
However, in planning programs, it is important to be aware that these approaches may
require formal identification or resident status which can constrain their use in displacement
contexts and with refugee populations.
In many cases it may be possible to find solutions to overcome these restrictions, such as
the aid agency fulfilling the role of bank account holder. The master (agency) account can
then host individual sub-accounts for beneficiaries, with each beneficiary’s money held in a
separate ‘wallet’ within the master account. These sub-accounts can be accessed through
linkage to an individual magnetic strip account card or smart card held by each beneficiary.
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Displacement Case Study 3:
Cash Support to Refugees through ATM Cards in Jordan
Since 2007, UNHCR has provided unconditional cash grants to almost 11,000 refugees in
Jordan through the Cairo Amman Bank. UNHCR holds a master bank account to which
the refugee’s ATM cards are linked, as refugees in Jordan are not allowed individual bank
accounts. Funds are credited to the cards each month, and refugees are informed by SMS
message when funds are transferred. They can then withdraw their money using their ATM
card. This approach has improved dignity as refugees avoid degrading queues. Beneficiaries’
satisfaction with the type of assistance and delivery mechanism is extremely high at 98%. In
addition, overhead costs of the program are low at 2% of the total budget in 2011.
Source: UNHCR, 2012. An Introduction to Cash-Based Interventions in UNHCR Operations.
Security
In conflict or recent post-conflict situations, it is important to assess the risk of cash being
misused for conflict-related activities such as the purchase of weapons. It may also be
important to ascertain if armed militias are likely to ‘tax’ any such payments. Similarly, if it is
widely known that residents of a village have been recipients of cash transfers, the risk of
the village being raided and robbed by militia groups needs to be considered.
Although challenges related to security are important considerations, they can frequently
be overcome though good program design. Cash interventions have now been successfully
used in highly insecure contexts such as Somalia and Afghanistan over a number of years.
Detailed response analysis, beneficiary acceptance of proposed approaches, secure
distribution mechanisms and effective monitoring throughout the project can all contribute
to minimizing potential security issues.
Cash assistance can be less visible than in-kind aid, particularly when hand-to-hand delivery
at distribution points is avoided by the use of new technologies. This can reduce the risk of
extortion or theft of cash from beneficiaries, or ‘taxation’ by militias or power-holders.
Value-denominated voucher programs (particularly voucher fairs) are frequently used in
conflict situations to minimize risk of diversion and threats to the security of beneficiaries
and program staff, by removing the need for handling large amounts of cash. Payments
to traders can be made directly into their bank accounts on redemption of the vouchers.
Vouchers can also be cancelled in the event of theft or extortion, and can provide a good
alternative in insecure environments if secure cash distribution channels are not available
and the storage of cash at a project or household level is an issue.
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Complementary Programs
Critical to the effectiveness of cash based programs for resettlement or reintegration is the
extent to which the ‘package’ of measures provided successfully addresses the resettlement
or reintegration needs of affected populations, including shelter, WASH, education, health,
land issues, and livelihoods. Cash should be viewed within the context of a comprehensive
support package to assist the return/reintegration of the displaced. As such, it is likely to
work best when combined with other multi-sectoral forms of assistance designed to address
reintegration or resettlement needs. For example, training in basic financial management
skills, or internal savings and lending groups, can promote savings and encourage better
management of the cash grant and any other household income. Setting the Payment Rate
In determining the level of the grant and what, if any, other elements the ‘package’ should
contain, it is important to conduct a comprehensive needs assessment. This should include
a rapid market situation analysis of local markets for relevant goods.
The appropriate level of payment provided by the cash transfer provided will vary according
to the estimated the cost of the activity or assistance which the grant was intended to cover.
The level of cash grants should take into account local standards and conditions (i.e.
not excessively high) to avoid creating large disparities with the receiving population.
National poverty lines and the size of governmental social assistance grants may assist in
determining the appropriate size of the grant in contexts where it is desirable for refugees’
living conditions to be comparable to those of the local population so as to avoid creating
tensions or conflict.
“Transport” grants should vary according to the distance covered. To avoid splitting family
groups, there should not normally be a cap on the maximum payable to large families.
The use of cash grants in repatriation operations in Afghanistan has been on-going
since 2002, and shows how the payment calculations have evolved over the years. Cash
payments were originally only intended to cover transport costs, and varied according to
the distance involved and the estimated cost of transport. Due to problems with instances
of grants being received ‘up front’ and repatriation not taking place, it was decided that for
long journeys payments would be made in stages along the route, using money traders and
the Hawala system. In 2004, most of the food and NFI components of the reintegration
package were replaced by an additional cash component intended to assist returnees in
meeting their basic needs for two to three months following repatriation.
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Displacement Case Study 4:
Cash Grants for Hosting of Syrian Refugees in Lebanon
In 2011, the Norwegian Refugee Council (NRC), in coordination with UNHCR, provided
cash grants to support families in North Lebanon to host Syrian refugees. The grant was
conditional on the host family allowing the refugees to stay for a minimum of one year and
not demanding any additional housing-related costs from the refugees.
The size of the grant varied based on an assessment of the rehabilitation work required to
bring the shelter up to minimum emergency standards. These assessments were carried out
by NRC technical staff and the grant was calculated based on a pre-defined bill of quantities.
A market survey had shown that prices were as much as 50% higher in the north of Lebanon
due to the security situation. The survey also found access constraints for contractors and
suppliers. Both findings had to be reflected in the size of the grant.
The average cost per shelter was around $1,850 USD, ranging from $300 USD to $4,000
USD. Repairs carried out involved doors, windows and roofs, installation of sanitation
facilities and connections to a water supply and sewage system. The grant was paid in three
instalments following quality checks by technical staff, with the final payment made on
completion of the shelter.
Source: UNHCR, 2012. An Introduction to Cash-Based Interventions in UNHCR Operations.
The use of the grant can be influenced by the place of distribution. Grants have been
distributed in various locations, including the place of asylum, the border, and on arrival
at the place of return/origin. Distribution in the country of origin is generally regarded as
best practice, as it ensures that return has actually taken place (at least temporarily) and
increases the likelihood of the grant being spent on return-related expenses. If paid in the
country of exile, refugees may accept the voluntary repatriation grant but not return home
(e.g. Ethiopia, 2002).
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Monitoring and Evaluation
Detailed guidance on monitoring and evaluation of cash for displacement/refugee projects
is provided in the Practical Tools Guide. However, key considerations include:
Monitoring procedures to reduce ‘recycling’ of refugees can be strengthened through
the use of biometric identification, such as iris scanning and fingerprinting, at voluntary
repatriation centers.
Agencies should closely monitor the environment in which the cash grant is to be used
(market prices, availability of goods, additional needs) and how the cash grant is spent,
including any unexpected outcomes or expenditures.
Impacts of the grant on the beneficiaries themselves and on their host communities
need to be monitored, as do relationship issues between the two groups.
Reintegration grants have to be carefully monitored to ensure that they fulfill their
intended purpose and achieve sustainable reintegration.
Further Reading
F. Troger and V. Tennant, 2008. The use of cash grants in UNHCR voluntary repatriation
operations. Report of a “lessons learned” workshop. Policy Development and Evaluation
Service. UNHCR PDES/2008/09.
UNHCR, 2012. An Introduction to Cash-Based Interventions in UNHCR Operations. Public
Health and HIV Section, UNHCR, March 2012. Geneva. [email protected]
Women’s Refugee Commission, “Building Livelihoods: A Field Manual for Practitioners in
Humanitarian Settings”, 2009, chapter on For Work Programming and Building in Camp
Economies, pp. 56 – 113.
IFRC, 2012. Assisting Host Families and Communities After Crises and Natural Disaster - A
Step-by-Step Guide. International Federation of Red Cross and Red Crescent Societies.
K. Haver, F. Hatungimana, and V. Tennant, 2009. Money Matters. An Evaluation of the Use of
Cash Grants in UNHCR’s Voluntary Repatriation and Reintegration Programme in Burundi.
UNHCR, July 2009.
E. Davin, V. Gonzalez, and N. Majid, March 2009. UNHCR’s Voluntary Repatriation Program:
Evaluation of the Impact of the Cash Grant. Commissioned by UNHCR in Kabul. Altai
Consulting, Afghanistan.
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Endnotes:
Summers, 1994. Investing in all people: educating women in developing countries. EDI
Seminar Paper No. 45. World bank. Washington DC. Also referenced in: Chapman, 2006,
DFID
Chapman, 2006. DFID.
EPRI Chapter 9. Citing DFID Practice paper (2005, page 14; Barrientos and Lloyd-Sherlock
(2002:12), citing De Carvalho Filho (2000), Deveraux (2001:44), Samson et.al. (2004).
Skoufias, 2005. IFPRI Research Report Abstract 139. Cited in Chapman 2006.
An analysis by Mexico’s Ministry of Social Development (SEDESOL)
Maluccio et al. 2010. Published in the Journal of Development Effectiveness in 2010. Cited
in Ozler Blog Post, World Bank website, 11-1-2012
Escobar-Latapí et al 2005
Coady, Grosh and Hoddinott 2004. The targeting of transfers in developing countries:
review of experience and lessons. World Bank. Washington D.C.
A. Glassman, J. Todd and M Gaarder, 207. performance based incentives for Health: CCT
programs in Latin America and the Carribean
Save the Children in Vietnam.
UNHCR, 2008a
Jaspars and O’Callaghan, 2010
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