Health first! This week witnessed the release of two fantastic metanalyses quantifying the impacts of cash transfers on a range of health-related outcomes. One of the papers is by Neelsen et al and compares the health performance of demand-side incentives – including performance-based financing, vouchers and conditional cash transfers – based on 58 evaluations generating 212 impact estimates. They found that “… performance-based financing is slightly less effective in improving maternal and child health coverage than voucher and conditional cash transfers schemes”. Among the key indicators, cash increased the probability of pregnant women having four or more antenatal care visits by 4.42 percentage points; the likelihood of vaccinations against tetanus went up by 2.38pp; delivery in a health facility soared by 7.29pp; receiving postnatal care increased by +3.09pp; and full child vaccination rose by 5.02pp.
The other brilliant health-related paper is by Cirillo et al. Their review involves social assistance more widely (both cash and food transfers), it’s slightly more multisectoral, and breaks down results for adolescents. They find that social assistance has consistently positive effects on health service utilization, school enrollment and attendance, food security, mental health as well as marriage reduction. However, they more mixed results were detected for learning, pregnancy, and work (see table 9, p.35-36 for a great overview).
Zooming into a particular dimension of health… a four-arm trial conducted by Soofi et al in Pakistan’s Rahim Yar Khan compared (i) unconditional cash transfers (UCT) vs (ii) UCT and lipid-based nutrient supplements (LNS) vs (iii) UCT + LNS + social and behavior change communication (SBCC) vs (iv) UCT + SBCC. Which was more effective to prevent stunting among children 6-23 months of age? Relative to cash alone, a 15% and 14% reduction in the prevalence of stunting was found in the UCT+LNS and UCT+LNS+SBCC arms, respectively. No impact was found for UCT+SBCC (and no effects by all arms on wasting and underweight) (h/t Amber Peterman).
Bonus on food security in South Asia: a blog by Dizon on “minimum cost of a healthy diets” shows that these range from $1.60 per person per day in Bangladesh to $2.90 in Sri Lanka – important to bear in mind when calibrating the adequacy of social assistance transfers! See also the full working paper by Dizon et al (h/t Mamta Murthi).
Moving to the Middle East, with new evidence on cash transfers to Syrian refugees in Lebanon! Moussa et al examine the effects of a cash transfer of $175 per household/month over 12 months. Yet changes in the PMT formula during implementation resulted in substantial changes in eligibility, hence creating different periods of program participation (between 10-22 months) and comparisons with both discontinued non-recipient groups. So, what’s the impact? Cash transfers incentivized shifts to formal schooling (+7.6-8.8 percentage points), reduced child labor (-2.9-3.7pp), lowered the chance of reporting a severe illness like diarrhea and respiratory infections (-8-10pp), and curbed the probability of early marriage among girls aged 15-19 years (-2.4-6.6pp).
Let’s stay in the humanitarian space: while state-led social protection took center stage in Covid response, a new report commissioned by the British Red Cross finds 86% of surveyed practitioners stated that the response involved large or some increase in localization relative to the past. In other words, “… responding to Covid-19 has been far more locally led than earlier humanitarian action”. While imbalances persisted, the pandemic “… has prompted a realisation among some that international surge capacity does not need to be deployed as standard. In many contexts, the absence of international staff (…) meant that local actors had a greater sense of agency, even when international staff offered online technical assistance”.
And speaking of Covid-19, Miguel and Mobarak have a great review of “pandemic economics”, i.e., evidence, responses, and gaps in low and middle income countries: among the many interesting reflections they note that “… [t]here is evidence that cash transfers can mitigate the adverse economic and mental and physical health consequences of COVID-19”.
More on the pandemic: in Ukraine, a new UNICEF report finds that “… 1.1 million people stayed above the poverty line [and] [c]hild benefits helped to prevent 149 thousand children from falling into poverty” (h/t Pamela Dale). Grim bonus: in the UK four companies allegedly used to access pandemic furlough funds illegally (h/t Hugo Slim).
Labor markets! An OECD policy brief highlights how countries have responded to the crisis in adapting and expanding the suite of active labor market programs: among the findings, it argues that 76% of OECD and EU countries moved training online and 70% introduced new online courses, while 28% have also funded additional places in institutional training.
News on financing? Energy subsidy reforms are a frequently mentioned options, but also a sensitive one: McCulloch et al document that between 2005 and 2018, 41 countries had at least one riot directly associated with popular demand for fuel. And in Sub-Sahara Africa, a regional fiscal review by Moore finds that “… [i]t is difficult for African governments to effectively tax transnational corporations, especially in the mining and energy sectors, which are of growing importance. Tax administrations continue to approach richer Africans with a light touch, and to exaggerate the potential for taxing small-scale (‘informal’) enterprises”.
Assorted mix! Ardington et al estimate that in South Africa, school closures resulted in up to 70-81% of loss in learning; Borkowski et al estimate that 1.6 billion learners in 199 countries worldwide were affected by school closures, with nearly 370 million children not receiving a school meal in 150 countries; and data underpinning the 2021 multidimensional poverty index is now available online (plus do-files).
Let’s round it up with events: interested in “stress-testing” social protection? Join us on Oct 21 (9:30-10:30am ET) for the launch of our new stress-test tool to rapidly assess countries’ potential to scale up and adapt cash transfers. The Cash Transfer Lab has a meeting on Oct 18 (2pm ET) on the effects of the Alaska Permanent Fund dividends on childbearing (you have to direct message them on tweeter to get a zoom link). And UNICEF hosted an event when Spain discussed its plan of action against child poverty.
Ugo Gentilini is from the World Bank’s Social Protection & Jobs global practice. The Social Protection Links newsletter, issued every Friday, distills and discusses a selection of curated resources on the topic, from academic articles to podcasts. The blog is republished on socialprotection.org each week, offering knowledge on social protection to helps you stay on top of it — succinctly, regularly and frequently. Previous editions can be found here.