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General

Study Overview

Title:

Ghana LEAP 1000 Impact Evaluation

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-55942496d53af

Initial Registration Date:

07/01/2015

Last Update Date:

01/24/2020

Study Status:

Completed

Change History for Status

Changed On	Previous Value
01/24/2020	In Development

Location(s):

Ghana

Abstract:

This study is an impact evaluation of a social cash transfer programme implemented by the Government of Ghana. The study is conducted by the UNICEF Office of Research in collaboration with the University of North Carolina and ISSER, University of Ghana. The programme, LEAP 1000, targets pregnant women and mothers of children under 1 year and is an extension of the Livelihoods Empowerment Against Poverty (LEAP) programme, Ghana’s flagship poverty alleviation programme. The impact evaluation aims to understand the extent to which LEAP 1000 can reduce household poverty and vulnerability, with a focus on children’s health and nutrition status, and will utilize a regression-discontinuity study design. Approximately 2,500 households will be followed over two years in a mixed-methods study. Quantitative surveys will be conducted at baseline and after 24 months, and 16 treatment households will be selected for in-depth interviews at baseline, 12 months, and 24 months. Health facility and community price questionnaires will also be administered at baseline. Results will help the Government of Ghana in the design and targeting of future social protection programmes.

Change History for Abstract

Changed On

Previous Value

01/24/2020

This study is an impact evaluation of a social cash transfer programme implemented by the Government of Ghana. The study is conducted by the UNICEF Office of Research in collaboration with the University of North Carolina and ISSER, University of Ghana. The programme, LEAP 1000, targets pregnant women and mothers of children under 1 year and is an extension of the Livelihoods Empowerment Against Poverty (LEAP) programme, Ghana’s flagship poverty alleviation programme. The impact evaluation aims to understand the extent to which LEAP 1000 can reduce household poverty and vulnerability, with a focus on children’s health and nutrition status, and will utilize a regression-discontinuity study design. Approximately 2,500 households will be followed over two years in a mixed-methods study. Quantitative surveys will be conducted at baseline and after 24 months, and 16 treatment households will be selected for in-depth interviews at baseline, 12 months, and 24 months. Health facility and community price questionnaires will also be administered at baseline. Results will help the Government of Ghana in the design and targeting of future social protection programmes.

Registration Citation:

Handa, S., Osei-Akoto, I., Palermo, T., De Groot, R. and Barrington, C., 2015. Ghana LEAP 1000 Impact Evaluation. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie066

Categories:

Agriculture and Rural Development
Health, Nutrition, and Population
Social Protection

Additional Keywords:

regression discontinuity, cash transfer, stunting, nutritional status, social protection

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Sudhanshu Handa & Isaac Osei-Akoto

Affiliation:

UNICEF Office of Research - Innocenti & Institute of Statistical, Social and Economic Research (Ghana)

Name of Second PI:

Tia Palermo, Richard de Groot, Clare Barrington

Affiliation:

UNICEF Office of Research - Innocenti, University of North Carolina

Study Sponsor

Name:

USAID & UNICEF

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Institute of Statistical, Social and Economic Research (ISSER)

Type of Organization:

Research institute/University

Location:

Ghana

Intervention

Intervention Overview

Intervention:

The Livelihoods Empowerment Against Poverty (LEAP) programme is Ghana’s flagship poverty alleviation programme, implemented by the Department of Social Welfare (DSW) at the Ministry of Gender, Children and Social Protection (MoGCSP), since 2008. The programme provides cash payment to extremely poor households with orphans and vulnerable children, the destitute elderly and persons with acute disability. The programme currently reaches about 90,000 extremely poor families in all 10 regions of Ghana. LEAP 1000 represents an expansion of LEAP to households with pregnant women and infants. Targeting children in the first 1000 days of their life is expected to improve child nutritional status and reduce stunting in Ghana. This pilot intervention, being rolled out almost exclusively in rural areas in 10 districts in Northern Ghana, aims to target 6,000 households and consists of bi-monthly cash transfers delivered to eligible women and enrollment in the national health insurance scheme. The pilot is expected to run for three years.

Change History for Intervention

Changed On

Previous Value

01/24/2020

The Livelihoods Empowerment Against Poverty (LEAP) programme is Ghana’s flagship poverty alleviation programme, implemented by the Department of Social Welfare (DSW) at the Ministry of Gender, Children and Social Protection (MoGCSP), since 2008. The programme provides cash payment to extremely poor households with orphans and vulnerable children, the destitute elderly and persons with acute disability. The programme currently reaches about 90,000 extremely poor families in all 10 regions of Ghana. LEAP 1000 represents an expansion of LEAP to households with pregnant women and infants. Targeting children in the first 1000 days of their life is expected to improve child nutritional status and reduce stunting in Ghana. This pilot intervention, being rolled out almost exclusively in rural areas in 10 districts in Northern Ghana, aims to target 6,000 households and consists of bi-monthly cash transfers delivered to eligible women and enrollment in the national health insurance scheme. The pilot is expected to run for three years.

Private Intervention Details:

Theory of Change:

As in most cash transfers targeted to extremely poor households, the immediate impacts of cash programmes are typically improved food security and an increase in consumption, particularly on items such as food, clothing, and shelter which influence children’s health, nutrition, and material well-being. Once immediate basic needs are met, the cash may then trigger further responses within the household, for example, such as using available resources for investment and other productive activity or accessing services, and changes in time use, including influencing children’s participation in chores, productive activities and school attendance.

We first expect direct effects of the cash transfer on household consumption (food security, diet diversity, basic needs, improvements to dwelling) and the use of services (health care). Free access to NHIS may induce households to use health services, and this increased use of services is a potential mediator, or mechanism through which LEAP impacts other outcomes of interest (feeding, nutrition, morbidity). The impact of the cash may work through several additional pathways (mediators), including intrahousehold resource allocation, women’s agency, levels of stress, and caregivers’ knowledge, attitudes, and practices. Similarly, the impact of the cash transfer may be weaker or stronger depending on local conditions in the community (these conditions are referred to as moderators).

The next step is the effect on children, which we separate into older and younger children. Any potential impact of the programme on children must work through the household and caregiver pathways including spending or time allocation decisions. Finally, we also examine woman-level outcomes, including self-perceived health and well-being, both to understand impacts on women’s wellbeing as a result of LEAP 1000, and because caregiver wellbeing can have a direct influence on child wellbeing.

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Department of Social Welfare (DSW) at the Ministry of Gender, Children and Social Protection (MoGCSP)

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:

USAID

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

05/22/2015

End Date:

09/01/2018

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Regression discontinuity

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (specify)

Other (not Listed) Method:

Embedded qualitative study

Method Details

Details of Evaluation Approach:

The Ghana LEAP 1000 evaluation study consists of a quantitative evaluation using regression discontinuity design (RDD) methods and an embedded qualitative study. Mobile units were deployed in 10 districts to advertise the program and enroll women, representing a demand-driven approach. All applicants were subjected to the LEAP proxy means test (PMT) to ensure they meet poverty criterion. The evaluation sample consists of approximately 1250 treatment women and 1250 comparison women, drawn from the group of women scoring just below and just above the PMT poverty threshold, respectively. A baseline quantitative, multi-topical survey will be conducted prior to enrollment into the program, and a follow-up survey will be conducted with the same households at 24-months. 16 treatment households will be selected for in-depth interviews at baseline, 12 months, and 24 months. Health facility and community price questionnaires will also be administered at baseline. GPS coordinates will be captured for each health facility and household in the sample.

Given the use of the RDD design to construct a treatment and comparison group with similar characteristics and outcomes at baseline, our estimation strategy employs a difference-indifferences (DID) design to compare the two groups. This design estimates programme impact by comparing changes in the treatment group between the baseline (2015) and endline (2017) to changes in the comparison group over the same time period, controlling for household- and district-level differences between the two groups. This methodology nets out changes that may have occurred over time due to other factors (e.g., floods, recession, inflation, rapid economic development) as the comparison group would have experienced these as well, thus resulting in more accurate estimates of programme impact.

Change History for Details of Evaluation Approach

Changed On

Previous Value

01/24/2020

The Ghana LEAP 1000 evaluation study consists of a quantitative evaluation using regression discontinuity design (RDD) methods and an embedded qualitative study. Mobile units were deployed in 10 districts to advertise the program and enroll women, representing a demand-driven approach. All applicants were subjected to the LEAP proxy means test (PMT) to ensure they meet poverty criterion. The evaluation sample consists of approximately 1250 treatment women and 1250 comparison women, drawn from the group of women scoring just below and just above the PMT poverty threshold, respectively. A baseline quantitative, multi-topical survey will be conducted prior to enrollment into the program, and a follow-up survey will be conducted with the same households at 24-months. 16 treatment households will be selected for in-depth interviews at baseline, 12 months, and 24 months. Health facility and community price questionnaires will also be administered at baseline. GPS coordinates will be captured for each health facility and household in the sample.

Private Details of Evaluation Approach:

Outcomes (Endpoints):

The quantitative survey instrument will be based on the programme’s conceptual framework (see attachment) and will measure key outcome and impact indicators (e.g. anthropometry) as well as intermediate outcomes, those that lie along the causal pathway (e.g. food consumption and diet diversity). Key outcome indicators include: Nutrition outcomes (stunting, wasting, underweight); Nutrition and health inputs (preventive and curative care services, infant and young child feeding, and diet diversity); Health outcomes (morbidity); Household consumption and food consumption. Intermediate outcomes and potential modifiers include: Productive livelihoods; Caregiving practices, caregiver’s knowledge; Stress and social support; Women’s agency and time use; Domestic violence; Water, sanitation and hygiene practices.

Change History for Outcomes (Endpoints)

Changed On

Previous Value

01/24/2020

The quantitative survey instrument will be based on the programme’s conceptual framework (see attachment) and will measure key outcome and impact indicators (e.g. anthropometry) as well as intermediate outcomes, those that lie along the causal pathway (e.g. food consumption and diet diversity). Key outcome indicators include: Nutrition outcomes (stunting, wasting, underweight); Nutrition and health inputs (preventive and curative care services, infant and young child feeding, and diet diversity); Health outcomes (morbidity); Household consumption and food consumption. Intermediate outcomes and potential modifiers include: Productive livelihoods; Caregiving practices, caregiver’s knowledge; Stress and social support; Women’s agency and time use; Domestic violence; Water, sanitation and hygiene practices.

Unit of Analysis:

Children, cash transfer recipients, households

Hypotheses:

1. Ghana LEAP 1000 will increase food security and expenditures of treatment households. 2. Ghana LEAP 1000 will improve child nutrition and anthropometric outcomes. 3. Ghana LEAP 1000 will have a positive impact on children’s health outcomes. 4. Ghana LEAP 1000 will improve children’s health inputs, such as use of preventive and curative care services, infant and young child feeding, and diet diversity. 5. Programme impacts on children’s health and nutritional status will be modified by recipient’s characteristics, including education, decreased experience of violence, lower levels of stress, and improved empowerment. 6. Availability of services at the community-level (markets and health facilities) will moderate programme impacts on child nutritional status.

Change History for Hypotheses

Changed On

Previous Value

01/24/2020

1. Ghana LEAP 1000 will increase food security and expenditures of treatment households. 2. Ghana LEAP 1000 will improve child nutrition and anthropometric outcomes. 3. Ghana LEAP 1000 will have a positive impact on children’s health outcomes. 4. Ghana LEAP 1000 will improve children’s health inputs, such as use of preventive and curative care services, infant and young child feeding, and diet diversity. 5. Programme impacts on children’s health and nutritional status will be modified by recipient’s characteristics, including education, decreased experience of violence, lower levels of stress, and improved empowerment. 6. Availability of services at the community-level (markets and health facilities) will moderate programme impacts on child nutritional status.

Unit of Intervention or Assignment:

Households

Number of Clusters in Sample:

no clusters

Number of Individuals in Sample:

2500

Size of Treatment, Control, or Comparison Subsamples:

Treatment: 1250 and Comparison: 1250

Supplementary Files

Analysis Plan:

Other Documents:

Ghana LEAP 1000 Conceptual Framework: Ghana LEAP 1000 Conceptual Framework.pdf

Data

Outcomes Data

Description:

Household survey of 2500 households. Key modules include: education, health, time use and employment, non-farm enterprises, reproductive health, birth history, maternal and newborn health, child health, immunizations, child nutrition and feeding, fertility preferences, domestic violence, housing conditions and WASH, productive livelihoods, subjective well-being, household consumption, women’s agency, stress and preferences, nutrition & feeding knowledge, anthropometry.

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

08/22/2017

Unit of Analysis:

Household, mother, child

Clusters in Final Sample:

no cluster randomization

Total Observations in Final Sample:

Households: 2,331 (in each wave). Children: 6,639 (pooled sample across waves)

Size of Treatment, Control, or Comparison Subsamples:

Households: Treatment=1,185 Comparison=1,146. Child nutrition: BL T: 1,416 BL C: 1,285 FU T: 2,035 FU C: 1,903

Findings

Preliminary Report:

Yes

Preliminary Report URL:

https://transfer.cpc.unc.edu/wp-content/uploads/2020/01/LEAP1000_Report_Final-2019-for-dissemination.pdf

Summary of Findings:

Conclusion: Results from this impact evaluation demonstrate that LEAP 1000 improved well-being of
households in terms of consumption, had protective impacts against poverty despite a trend of increased
poverty in the sample, positively impacted some areas of economic productivity and savings, increased
use of health services for adults, and increased social support. Furthermore, we found no increases in
fertility as a result of the programme. Nevertheless, we found no impacts on one of LEAP 1000’s primary
objectives, namely child stunting and nutrition. Given that child nutrition and stunting are determined by
a complex set of inputs, this result, combined with the lack of programme impacts on drinking water and
sanitation (a few such determinants), suggest that while cash and health insurance are important
components to improving child welfare, more linkages with health and social services and complementary
WASH interventions are needed to reduce child stunting.

Paper:

Yes

Paper Summary:

Paper Citation:

Palermo T, Valli E, Angeles G, Barrington C, Adamba C, Spadafora T, On Behalf of the LEAP 1000 Evaluation Team. (2019). Impacts of a social protection program paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme. BMJ Open, 9(11). de Groot R, Yiryele Kuunyem M and Palermo T on behalf of the Ghana LEAP 1000 Evaluation Team. (2018). Child marriage and associated outcomes in Northern Ghana: a cross-sectional study. BMC Public Health, 18: 285.

Data Availability

Data Availability (Primary Data):

Yes--Available in the future

Date of Data Availability:

Data URL or Contact:

https://transfer.cpc.unc.edu/tools/data-2/

Access procedure:

Other Materials

Survey:

Yes

Survey Instrument Links or Contact:

https://transfer.cpc.unc.edu/instruments/ghana-instruments/

Program Files:

No

Program Files Links or Contact:

https://transfer.cpc.unc.edu/

External Link:

https://transfer.cpc.unc.edu/countries-2/ghana-2/

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: