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How cash-based approaches affect nutrition outcomes: Case studies from World Vision cash programmes in Bangladesh and South Sudan - June 2019

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Executive Summary

Introduction

Cash and voucher programming (CVP) is a humanitarian intervention method used to help vulnerable populations meet their basic needs with flexibility and dignity. Increasingly, humanitarian actors are using this intervention method to contribute to improving nutrition outcomes for target populations. There is some evidence that CVP has a positive effect on household dietary diversity, health seeking behaviour and hygiene practices, which in turn have a positive impact on nutrition outcomes for mothers and children. However, there is limited evidence about the impact of different types of cash modalities, or how exactly cash works alongside complimentary interventions.

This research case study, commissioned by World Vision, aims to contribute to the evidence and learning around how CVP contributes to nutritional outcomes for mothers and children. It does this by documenting lessons, recommendations and best practices emerging from World Vision cash-based programmes in two contexts: Bangladesh and South Sudan. The case study aims to answer two primary research questions:

  1. To what extent is cash-based programming an appropriate programme modality for achieving nutrition outcomes in the given contexts?

  2. What is the evidence of impact of the cash-based programming on nutrition outcomes? What factors related to cash-based programming have facilitated or hindered the achievement of nutrition outcomes?

Methodology

This case study took a mixed-methods approach, involving a desk review, key informant interviews, focus group discussions, and an analysis of project post distribution monitoring (PDM) data. In total, 33 interviews were conducted with project staff and partners across both countries, and 11 were conducted with cash recipients. Eight focus group discussions were conducted (four per country) with cash recipients. All participants were pregnant or lactating women, or mothers with children under the age of five. In total, 91 women participated in these focus groups.

Analysis of qualitative data was conducted by coding completed response sheets and using thematic analysis in NVivo, and quantitative analysis of project PDM data was conducted using regression analysis and descriptive statistical techniques in R.

Cash project overviews: Bangladesh and South Sudan

The cash transfer project in Bangladesh is part of a large five-year USAID food security and resilience programme called Nobo Jatra, which began in 2015. The conditional cash transfer element aimed to provide a nutritional safety net to pregnant and lactating women who live below the lower poverty line in Bangladesh, and provided a monthly cash transfer of 2200 taka (27.50 USD) to these “ultra poor” women for 15 months during their pregnancy and after the birth of their child. These cash transfers are conditional upon healthcare check-ups before and after birth, as well as attendance at social and behavioural communication change sessions.

In South Sudan, the Juba Urban Cash Project is a cash transfer and capacity building project that began in 2016 and is implemented by World Vision in partnership with the World Food Programme. The project began as a pilot in 2016 and is currently in its fourth phase. The cash transfers for all phases of the programme have involved six months of monthly transfers, conditional on attendance at monthly training sessions. The cash transfer amount is 45 USD, and this amount varies in South Sudanese Pounds (SSP) depending on fluctuations in the exchange rate. The programme targets various vulnerable households, and a large proportion of beneficiaries are pregnant or lactating women or women with undernourished children.