Since 2015, Burkina Faso has been facing a humanitarian and security crisis of unprecedented scale. Already affected by chronic food and nutrition insecurity, the country has now witnessed security incidents that have led to the internal placement of some 900,000 people and have affected 1.3 million families in the host communities.1 Public services and infrastructure have been seriously impacted and are now operating at a minimal capacity or have been closed. Sahel is one of the regions of Burkina Faso that has been hardest hit and has a global acute malnutrition (GAM) rate of 12.8%,2 which is well above the alert threshold of 10% set by WHO.
The NGO HELP (Hilfe zur Selbsthilfe) has been active in Burkina Faso’s Sahel region since 2008 and has successfully carried out interventions to strengthen the health system and fight malnutrition. In 2018, HELP obtained funding from ECHO for a project to fight acute malnutrition in Sebba health district. Within the framework of that project, HELP introduced cash transfers to pay the costs of transporting children suffering from severe acute malnutrition to the Intensive Nutritional Recovery and Education Centre (CRENI) in Sebba.
The idea of including “money for transport” is based on the observation that despite the policy of free care for children under the age of five, the cost of crossing the seasonal lakes during the rainy season constituted a considerable financial obstacle for poor households and discouraged them from promptly attending the CRENI.
The chosen transfer modality consisted of a conditional and unrestricted cash transfer of FCFA 5000 (approximately €7.60), the price of a return trip by canoe. To encourage parents to stay until the end of their child’s treatment, beneficiaries only received the money at the end of their time at the CRENI. This cash-based intervention was part of a wider range of activities aimed at strengthening the health system, community mobilisation and nutrition surveillance to combat child malnutrition.
Although it is difficult to evaluate which effects are attributable solely to the “money for transport” component of a health and nutrition project, positive results were observed with quicker treatment of cases of SAM, an increase in CRENI attendance (up 50%) and a reduction in the mortality rate for cases of SAM during the cash distribution period compared with 2018 (down 23.7%).
However, there were numerous challenges, particularly in setting up and monitoring this pilot activity. The project team also learned a number of lessons, for instance about the importance of good coordination between the community dimension and the medical dimension, to optimise the impact of the cash transfer.