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Improving childhood outcomes – is cash enough?

by Madison Little and Keetie Roelen

In short: it depends…

Providing parents with cash is now common practice across the world in the fight against child poverty. From the UK to South Africa, large-scale child benefit programmes offer economic support to those caring for children.

In recent years, so-called ‘cash-plus’ interventions that combine cash with additional transfers, interventions, or services have become increasingly popular in a bid to strengthen the impact of cash transfers. This is in recognition of the fact that cash alone does not suffice to address the multidimensional nature of poverty and vulnerability – especially for children. The intervention’s complementary (‘plus’) components aim to improve effectiveness by motivating behaviour change (through parenting classes, for example) or addressing supply-side constraints (such as providing food supplements).

Despite the expansion of such cash-plus interventions, relatively little is known about the extent to which they are more effective than cash alone. A new systematic review examined whether providing cash and complementary support for infants and children under five improves their health and wellbeing more than cash transfers alone.

The review was framed against the Sustainable Development Goals (SDGs), looking at interventions that aimed to improve outcomes in relation to SDG2 (No Hunger), SDG3 (Good Health & Wellbeing), SDG4 (Education), or SDG16 (Violence Prevention). Seventeen studies were included in the review and eleven meta-analysed.

Most interventions were implemented during the first 1,000 days of the child’s life and were conducted in communities facing high rates of poverty and often, food insecurity. Five types of intervention categories were identified, namely those combining cash with nutrition behaviour change communication, food transfers, primary healthcare, psychosocial stimulation , and child protection interventions.

Findings are mixed. Cash-plus may be more effective than cash alone when combining cash with food transfers to prevent acute malnutrition and mortality in crises, and to reduce stunting in the long-term. Cash combined with primary healthcare is also more likely to further reduce mortality, while cash combined with nutrition behaviour change communication may lead to greater reductions in long-term poverty.

At the same time, findings also suggest limited or no added impact of nutrition behaviour change communication to improve child anthropometrics. Similarly, combining cash with psychosocial stimulation interventions did not bolster interventions’ positive impacts.

In sum, combining cash with complementary interventions can make interventions more effective, yet much depends on the package of support and how it is implemented. Ultimately, more research is needed on how to optimise the promise of cash transfers and multisectoral intervention packages for young children to achieve the Sustainable Development Goals by 2030.

Madison Little is DPhil Student at the Department of Social Policy and Intervention at University of Oxford. His thesis title is “Accelerating progress in achieving the Sustainable Development Goals for children and adolescents through multi-sectoral actions and structural interventions.”

Photo credit: Ngoc Vuong from Pexels

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