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Multi-purpose Cash Assistance in Lebanon: Impact Evaluation on the well-being of Syrian refugees - 20 March 2020

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EXECUTIVE SUMMARY

Since the onset of the Syrian crisis, the humanitarian community has increasingly relied on cash-based assistance provided from donor contributions and implemented by aid partners under the Lebanon Crisis Response Plan to support the affected population. In November 2017, the World Food Programme (WFP) joined the United Nations High Commissioner for Refugees (UNHCR) and non-governmental organisations (NGO) in the delivery of multi-purpose cash (MPC) to assist the most economically vulnerable Syrian refugee households to meet their basic needs. WFP provides a monthly unconditional and unrestricted transfer of $27 per person per month and a top-up of $173.50 to Syrian refugee households to stabilise or improve access to food and basic needs over a 12-month cycle.
This study aims to measure the short-term (12 months or less) and long-term (more than 12 months) causal impact of the $173.50 and $175 MPC assistance provided by WFP and UNHCR respectively, over and above the $27 per person per month assistance, as well as the impact of discontinuation from MPC on the well-being of Syrian refugees.

This report presents the causal impact on multiple dimensions of well-being, namely household expenditures, food security, housing, water, sanitation and hygiene (WASH), education, employment, health and decision-making. The key take-away messages from the study are:

  1. The impact of MPC materialised across most dimensions of well-being in the long-term, indicating the importance of households’ access to a longer duration of MPC.

  2. The benefits of MPC fade for many indicators within 4 to 10 months after discontinuation, and households’ well-being returned to pre-assistance levels for most indicators, and dropped slightly below the pre-assistance baseline for others.

  3. The findings would suggest that there are benefits to instituting longer cash cycles and/or linking MPC to other services through a ‘cash plus’ approach to expand and extend the positive impact of cash on beneficiary households and ensure sustainable impact.

A total of 11,457 households were visited and used in this analysis, which constitutes one of the largest samples among impact evaluations conducted in Lebanon to date. Key findings revealed in the research and analysis include:

Household expenditures: MPC led to a sizeable and significant increase in total reported monthly household expenditure (including food, rent, health etc.) from $486.90 in the control group to $581.90 in the long-term MPC group. No significant decrease in total expenditures was observed among the discontinued group compared to the control group. Receiving the MPC top-up lead to a significant increase for the long-term MPC group in food and cooking gas expenditures, which confirms the observed significant increase in the food quality and quantity and the decrease in the food insecurity experience of long-term MPC households.

Food security: Long-term MPC had a significant positive impact on the food security of households over and above any effect of the $27 cash assistance. The food insecurity experience of long-term MPC households decreased by a 0.9-point score (on a scale of 8 points). Over and above the $27 cash assistance, long-term MPC recipients had a minimal 6-point increase in the adapted Food Consumption Score (FCS) along with an increase in the consumption of cereals, vegetables, fish, eggs, and oil indicating a slight improvement in the food consumption and diet quality of households. Long-term MPC also lead to a $32.70 increase in recipient households’ food expenditures.

Housing and WASH: Access to sufficient drinking water was significantly higher for all treatment groups compared to the control group. No significant impact was detected in rent expenditures for any of the treatment groups. No significant impact was detected on residential housing and WASH outcomes such as access to toilets located inside the household.

Housing outcomes are largely dictated by a shortage of affordable quality housing that predates the Syria war, and was exacerbated by the rising demand for housing by the influx of refugees. Housing conditions cannot be tackled through MPC alone and require linkages with institutional and legal efforts to protect tenants’ rights. These could be pushed through municipal initiatives to institute yearly rental contracts, with provisions to protect against evictions and price increase.

Education: Formal school enrolment for children aged 5-14 increased significantly for short-term and long-term MPC groups. The positive impact was similar in magnitude among boys and girls. Reasons for non-enrolment also suggest that long-term MPC households are significantly less resource constrained in their enrolment decisions.

Employment: Long-term MPC appears to be increasing working males’ ability to choose work with better employment conditions according to the findings. For example, this was observed in a decrease in their employment by 17 percentage points, which was coupled by an increase of 10.6 percentage points in the rate of unemployed men who are not working but are actively looking for a better job, a finding that was confirmed qualitatively. In fact, access to any duration of MPC

was correlated with a lower probability of working in hazardous conditions or having a work injury among the employed in the target population.

The labour market impact of MPC is different for women. Long-term MPC appears to give women the option to leave the labour force and avoid low-paying and, often, hazardous jobs they would have otherwise had to take part in. Conversely, labour market dynamics for women in the discontinued group suggest that the loss of MPC depressed their reservation wage (the lowest wage they are willing to accept for a job). Results show a significant increase in employment (10.7 percentage points) coupled with a significant drop in unemployment (8.8 percentage points). This suggests that MPC allows women to prioritise household chores and childcare, the reasons reported for not looking for work in this assessment by 67.2 per cent of the working-age women. These dynamics were also confirmed by the qualitative findings of Economic Development Solutions’ (EDS) informal employment assessment.

Child labour is lower among all children in the 5-14 age group in the long-term MPC group. However, with baseline rates of child labour in the control group already very low, the difference in rates between the control and long-term MPC is not statistically significant.

Health: Households receiving long-term MPC reported a significant 8.3 percentage points increase in accessing any type of primary health care (PHC) compared to the control group. This increase in access was specifically significant for children under 5 and those between the ages of 5 and 19. This was paralleled by a significant decrease of 9.9 percentage points in the reported need for hospitalisation in the long-term MPC group compared to the control group.

MPC also had a positive impact on the mental health of respondents. Respondents who report good mental health increased significantly by almost three-fold from 18.5 per cent in the control group to 54.5 per cent in the long-term MPC group.

Decision-making: Results for females making sole or joint decisions were mixed for the multiple decision fields and were largely non-significant and inconclusive. There is a need to adapt the international tools used, based on the International Food Policy Research Institute (IFRI) and the Demographic and Health Survey (DHS) modules, to the local refugee context and explore the use of other potential indicators of decision-making in future studies.

This report concludes with a number of recommendations and evidence gaps including:

  1. Holding consultations with MPC and other cash actors in relevant working groups to revisit the duration of current cash cycles, or customise cash cycle durations based on the needs of beneficiary households.

  2. Conducting sector focused MPC impact evaluations to better understand the process behind the impact.
    Unpacking the causal mechanisms through a mixed methods approach could lead to a more detailed and accurate measurement of impact and provide a finer cross-sectional view rather than a general snapshot.

  3. Evaluating ‘cash plus’ interventions that are based on linkages between MPC and external services to better understand how combining cash assistance with complementary programmes can lead to achieving more effective sustainable impact.

Future assessments should focus on answering the below to guide the humanitarian sector and cash practitioners in their programming:

• What is supporting or inhibiting the impact of MPC on the studied outcomes of interest at the micro level (individual or household) and at the macro level (institutions, service providers, legal, political and socio-economic environment)?

• How are these external services and their quality affecting the impact of MPC on refugees’ well-being?

• What are the causal pathways through which MPC is improving the household’s well-being and access to quality services?