Alderman, Harold

Gilligan, Daniel

Leight, Jessica

Tambet, Heleene

Mulford, Michael

Mamo, Tigist

We explore the impact of different models of scalable nutrition services embedded within a light-touch graduation program, implemented at scale in Ethiopia. The graduation program provided poor households enrolled in Ethiopia’s national safety net, the Protective Safety Net Program (PSNP), with additional livelihood programming including savings groups, business skills training and linkages to financial services. In addition, extremely poor households received a one-time livelihood grant on an experimental basis, as cash transfers or in-kind poultry grants, at a value much smaller than lump sum transfers in other graduation model programs in recent literature. The experiment compared a core nutrition model of nutrition information and sanitation and hygiene activities to an enhanced model that added more intensive nutrition messaging, supplementary feeding of malnourished children, mental health services, and a male engagement activity. Results show that interaction with health care workers and participation in community health activities increased significantly under the enhanced nutrition model, as did maternal nutritional knowledge. Nevertheless, neither nutrition model led to significant improvements in child dietary diversity or anthropometric outcomes on average. However, cash livelihood grants combined with the enhanced nutrition model reduced childhood stunting.

Including scalable nutrition interventions in a graduation model program: Experimental evidence from Ethiopia

Karachiwalla, Naureen

Kassim, Yumna

El-Enbaby, Hoda

Kurdi, Sikandra

Women’s control over decision-making within their family, particularly regarding the use of household income, can play an important and long-lasting role in shaping their well-being and that of their children. Cash transfer programs often target women in order to increase their control over household resources. Empirical evidence on the effectiveness of this approach is mixed and suggests the importance of local context. We present evidence on the effect of cash transfers on women’s control over decision-making in the MENA region, where little evidence is available and where cultural norms around women’s roles differ from more-studied regions. Using a regression discontinuity approach, we identify the impact of Egypt’s “Takaful” national cash transfer program on women’s control over decision-making and labor supply. Receiving cash transfers mostly reduced women’s reported ability to influence household decisions, particularly regarding child healthcare. The loss of control over decision-making was greater for women with less than primary education. Other effects of the program include a decline in women’s employment and an increase in men’s involvement in spheres of decision-making usually controlled by women. These results are robust to changes in model specification. We present suggestive evidence from mediation analysis that the negative effects on women’s control over decision-making was directly related to these declines in employment and increase in men’s involvement in female spheres. The negative findings are not wholly supported by complementary qualitative work in which women reported more positive perceptions of the program’s impacts.

Cash transfers and women’s control over decision-making and labor supply in Egypt

Breisinger, Clemens

ElDidi, Hagar

Jilani, Amir Hamza

Thai, Giang

Egypt has been providing cash to poor households through its first conditional cash transfer program, Takaful and Karama, a social protection program run by the Ministry of Social Solidarity (MoSS), since March 2015. Takaful (“Solidarity”) supports poor families with children under 18, while Karama (“Dignity”) supports the elderly poor and people living with disabilities. The cash transfer program has enrolled 2.25 million families across all of Egypt’s governorates. The amount of the Takaful cash transfer provided to households depends on the number of children and their school level. The Karama program provides a set amount per individual. In order to reach the poorest households, participants are selected using a proxy means test. In the Takaful program, 89 percent of recipients are women, while only 11 percent are men. Beginning in 2018, Takaful will also begin implementing conditionalities, requiring households in the program to ensure their children attend school and participate in health screenings, added to antenatal care for pregnant women and post-natal care. The Takaful and Karama program was evaluated by the International Food Policy Research Institute (IFPRI) using both quantitative statistical methods (simple questions asked to many households during a survey) and qualitative methods (more in-depth questions asked to fewer households in longer interviews). The evaluation was designed to measure and explain the impacts of the cash transfers on household welfare, and to examine whether the program’s criteria for household selection were effective in identifying poor households. This brief, which focuses on the Takaful component of the program, summarizes the main findings from the evaluation and key recommendations.

Egypt’s Takaful and Karama cash transfer program: Evaluation of program impacts and recommendations

Jilani, Amir

This report of the evaluation study provides a greater focus on measuring the impact of the larger Takaful program and also attempts to measure the impact of the much smaller Karama program. In addition, IFPRI will conduct a qualitative assessment of the Takaful and Karama program focused on learning about the experience with the program among the poorest beneficiary households. This qualitative assessment will also draw lessons from the quantitative survey to provide another report on the experience of very poor households. The remainder of this report is organized as follows Chapter 2 provides an overview of the Takaful and Karama Program. Chapter 3 summarizes the impact evaluation design. Chapter 4 describes the evaluation survey and sample. Chapter 5 provides context for the program by using the survey data to summarize the characteristics of beneficiary and non-beneficiary households and describe beneficiaries’ experience with program implementation. Chapter 6 presents the impact estimates for Takaful and Chapter 7 the estimates for Karama. Chapter 8 uses data from a separate representative sample of households collected during the survey to assess the targeting performance of the program. Chapter 9 concludes and discusses implications for social policy in Egypt.

Impact evaluation study for Egypt's Takaful and Karama cash transfer program: Part 1: Quantitative report

Hidrobo, Melissa

Ethiopia has made major strides in improving nutrition in the past two decades; the prevalence of stunting decreased considerably from 58% in 2000 to 38% in 2016 and further to 37% in 2018.1 While there is no consensus on the underlying causes of this improvement—although substantial increases in income and education surely contributed—there is consensus that more must be done to maintain the momentum. In particular, a number of infant and young child feeding (IYCF) practices can be improved. While breastfeeding initiation is nearly universal, many children are not exclusively breastfed until they are 6 months old, which is the recommended practice. Similarly, few children age 6–23 months meet the minimum acceptable dietary standards. This brief presents evidence on the impact of the SPIR project on key IYCF practices at the time of the midline survey.

The effects of SPIR Interventions on nutrition and childcare: Evidence from the SPIR midline survey

Gilligan, Daniel

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