Attachments
REPORT OVERVIEW
This report is divided into four sections; Section 1 provides an overview of the Research on Food Assistance for Nutritional Impact (REFANI) project including a summary of the study sites and country contexts in which the studies were conducted. Section 2 describes the cash or voucher transfer interventions that were implemented in each site and the study designs that were used to test their effectiveness. Section 3 highlights the primary and secondary results for all three studies, and provides a summary table for ease of comparison. Study cost and cost-effectiveness findings are also contained in this section. Finally, Section 4 provides the discussion and conclusions which highlight the common findings across the three studies, as well as any key departures and differences.
SECTION 1
INTRODUCTION
1.0 THE REFANI PROJECT
The REFANI project was implemented to strengthen the evidence base on the nutritional impact and cost-effectiveness of cash and voucher transfers to populations affected by humanitarian emergencies.
The REFANI Consortium was comprised of two research partners, ENN and University College London (UCL), and two operational partners, Action Against Hunger and Concern Worldwide. The REFANI project was conducted over a four-year period between 2014 and 2017, with funding provided by UK aid from the UK government, and co-financing through humanitarian aid from the European Commission. Throughout this report cash and voucher transfer programmes are collectively referred to as cash based interventions (CBI).
As part of a comprehensive literature review, REFANI partners identified what was known about the nutritional impact of CBIs as well as the gaps that remained in the evidence base. We also developed a theory of change to explain the possible mechanisms through which CBI might impact on nutritional outcomes. Informed by our analysis of evidence gaps and the theory of change that we developed (see Annex), we then engaged in discussions with REFANI partners and others who were based in potential study countries. Together with our in-country partners, the consortium defined the specific research questions and designs which were implemented in a series of nutrition impact studies in Pakistan, Niger, and Somalia. In tandem with the nutritional effectiveness research, REFANI also conducted a costing and cost-effectiveness analysis (CEA) of the interventions.
This report provides a comparative analysis of the three country studies. It examines the commonality of findings as well as key differences and the implications of these findings for policy and decision makers and for programme implementers. For all three studies, the primary outcomes of interest were the effect of CBI on the risk of acute malnutrition and on mean weight for height (WHZ) in children 6-59 months of age. The studies also examined a set of secondary outcomes including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, water, sanitation, and hygiene (WASH), access to health care, maternal nutrition, linear growth of children, stunting, and haemoglobin (Hb) concentration. These secondary outcomes were not measured in all studies due to operational reasons but there was considerable overlap which is described in this report.
The Primary REFANI Research Question: Can CBI protect nutritional status in children (aged 6-59 months) in a range of crisis contexts?
It is recognised that the findings of three country studies, which were undertaken in markedly different country contexts (TABLE 1), cannot lead to generalisations that can be applied to the myriad of emergency contexts in which CBI are implemented. However, our findings should be of value to those concerned with CBI, particularly in humanitarian and fragile contexts.