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General

Study Overview

Title:

Impact of Cash Transfers and Nutritional Training on Child Malnutrition in Yemen

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-5b4eff881b29a

Initial Registration Date:

07/18/2018

Last Update Date:

10/21/2019

Study Status:

Completed

Change History for Status

Changed On	Previous Value
10/21/2019	Ongoing

Location(s):

Yemen

Abstract:

Even before the current conflict, Yemen had high levels of child nutrition. This evaluation seeks to measure the impact of a cash transfer and training program for women with children under 5 years old in Al Hodeidah governorate. Further, we will examine heterogeneity in treatment impact by baseline characteristics (e.g. mothers’ education and decision-making power of the women in the household). The evaluation methodology makes use of an RCT which was set up during the pilot period. The baseline was collected in January 2015. Because the program was paused due funding interruption during the conflict, by the final data collection in July 2017, the treatment group had received 9 months worth of transfers and control household remained untreated.

Change History for Abstract

Changed On

Previous Value

10/21/2019

Even before the current conflict, Yemen had high levels of child nutrition. This evaluation seeks to measure the impact of a cash transfer and training program for women with children under 5 years old in Al Hodeidah governorate. Further, we will examine heterogeneity in treatment impact by baseline characteristics (e.g. mothers’ education and decision-making power of the women in the household). The evaluation methodology makes use of an RCT which was set up during the pilot period. The baseline was collected in January 2015. Because the program was paused due funding interruption during the conflict, by the final data collection in July 2017, the treatment group had received 9 months worth of transfers and control household remained untreated.

Registration Citation:

Kurdi, S., 2018. Impact of Cash Transfers and Nutritional Training on Child Malnutrition in Yemen. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie145

Categories:

Health, Nutrition, and Population
Social Protection

Additional Keywords:

Cash transfers

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Sikandra Kurdi

Affiliation:

IFPRI

Name of Second PI:

Affiliation:

Study Sponsor

Name:

World Bank

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Yemen Social Fund for Development

Type of Organization:

Government agency (eg., statistics office, Ministry of Health)

Location:

Yemen

Intervention

Intervention Overview

Intervention:

The Cash for Nutrition provides conditional cash transfers to stimulate attendance at nutritional training sessions and improve nutrition outcomes through increased knowledge about nutritional practices. Participating households are eligible to receive quarterly cash payments, conditional on attendance at monthly community nutritional education sessions, malnutrition screening, compliance with supplemental feeding treatment in the case of malnutrition, and hospitalization for acute malnutrition and severe acute malnutrition. The program also provides training related to the importance of girls’ education. The intervention implements a soft conditionality approach whereby participants are encouraged to participate in activities but are not penalized for non-participation. The intervention targets all households identified as poor by Yemen’s national cash transfer program – Social Welfare Fund (SWF) with children 5 years old or younger in most of the districts in the Al-Hodeidah governorate. Beneficiaries receive cash payments of up to 10,000 riyals per month.

Change History for Intervention

Changed On

Previous Value

10/21/2019

The Cash for Nutrition provides conditional cash transfers to stimulate attendance at nutritional training sessions and improve nutrition outcomes through increased knowledge about nutritional practices. Participating households are eligible to receive quarterly cash payments, conditional on attendance at monthly community nutritional education sessions, malnutrition screening, compliance with supplemental feeding treatment in the case of malnutrition, and hospitalization for acute malnutrition and severe acute malnutrition. The program also provides training related to the importance of girls’ education. The intervention implements a soft conditionality approach whereby participants are encouraged to participate in activities but are not penalized for non-participation. The intervention targets all households identified as poor by Yemen’s national cash transfer program – Social Welfare Fund (SWF) with children 5 years old or younger in most of the districts in the Al-Hodeidah governorate. Beneficiaries receive cash payments of up to 10,000 riyals per month.

Private Intervention Details:

Theory of Change:

Nutritional training increases knowledge about correct practices for child feeding, while cash allows households to purchase more nutritionally diverse diets.

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Yemen Social Fund for Development

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:

UNDP through a World Bank Grant to Yemen

Type of Organization:

NGO (International)

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

06/07/2018

End Date:

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Difference in difference/fixed effects

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

Our impact evaluation strategy is based on random assignment of treatment. The eligibility screening prior to the 2014 baseline identified over 9000 households who were eligible for the nutrition intervention in the target districts of Bait al-Faqih, Al Murawa’a, and Zabeed; while the programs could accommodate only 4800 cases (individual slots) for operational reasons. According to the program design, 2868 of the 4800 slot were allocated to the “first priority” group made up of direct beneficiaries (households heads) or wives of direct beneficiaries. The remaining 1932 slots could be randomly assigned to the “second priority group,” i.e. cases where the mother is a son's wife, daughter, or other relative of the beneficiary other eligible woman (there were 7050 such second priority cases). The randomization was performed at the village level, i.e. from the list of villages with eligible “second priority” women only a subset of treatment villages was randomly drawn. Despite careful randomization differences between the treatment and control samples may occur in some dimensions due to the relatively small sample size. To control for this, we use differences in differences.

Change History for Details of Evaluation Approach

Changed On

Previous Value

10/21/2019

Our impact evaluation strategy is based on random assignment of treatment. The eligibility screening prior to the 2014 baseline identified over 9000 households who were eligible for the nutrition intervention in the target districts of Bait al-Faqih, Al Murawa’a, and Zabeed; while the programs could accommodate only 4800 cases (individual slots) for operational reasons. According to the program design, 2868 of the 4800 slot were allocated to the “first priority” group made up of direct beneficiaries (households heads) or wives of direct beneficiaries. The remaining 1932 slots could be randomly assigned to the “second priority group,” i.e. cases where the mother is a son's wife, daughter, or other relative of the beneficiary other eligible woman (there were 7050 such second priority cases). The randomization was performed at the village level, i.e. from the list of villages with eligible “second priority” women only a subset of treatment villages was randomly drawn. Despite careful randomization differences between the treatment and control samples may occur in some dimensions due to the relatively small sample size. To control for this, we use differences in differences.

Private Details of Evaluation Approach:

Outcomes (Endpoints):

1. Average calorie consumption of staple foods in past 2 days 2. Consumption of key non-staple foods in past week 2. Household Dietary diversity 3. Dietary diversity of women and young children 4. Child weight-for-height and height-for-age z-scores 5. Child illness in past 2 weeks 6. Child mortality 7. Child feeding knowledge and practices related to breastfeeding, complementary feeding and sanitation 8. Access to health services 9. Female empowerment (especially interest in education of girls)

Change History for Outcomes (Endpoints)

Changed On

Previous Value

10/21/2019

1. Average calorie consumption of staple foods in past 2 days 2. Consumption of key non-staple foods in past week 2. Household Dietary diversity 3. Dietary diversity of women and young children 4. Child weight-for-height and height-for-age z-scores 5. Child illness in past 2 weeks 6. Child mortality 7. Child feeding knowledge and practices related to breastfeeding, complementary feeding and sanitation 8. Access to health services 9. Female empowerment (especially interest in education of girls)

Unit of Analysis:

Household

Hypotheses:

Primary: The combination of cash transfers and nutritional training improves outcomes Secondary: Impacts are higher for women from poorer households, women with less nutritional knowledge at baseline, literate women, and women who are not living with in-laws

Change History for Hypotheses

Changed On	Previous Value
10/21/2019	Primary: The combination of cash transfers and nutritional training improves outcomes Secondary: Impacts are higher for women from poorer households, women with less nutritional knowledge at baseline, literate women, and women who are not living with in-laws

Unit of Intervention or Assignment:

Village

Number of Clusters in Sample:

180

Number of Individuals in Sample:

2000

Size of Treatment, Control, or Comparison Subsamples:

Treatment= 1000, Control=1000

Supplementary Files

Analysis Plan:

Other Documents:

Data

Outcomes Data

Description:

Household survey

Data Already Collected?

Yes

Data Previously Used?

No

Data Access:

Restricted -- Access requires a formal approval process

Data Obtained by the Study Researchers?

Data Approval Process:

Application to Yemen Social Fund for Development, UNDP, and World Bank

Approval Status:

Yes-obtained approval and have received the data

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:

Yes

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Non-Prospective, Category 4: Data for measuring impacts have been obtained/collected by the research team and analysis for this evaluation has started

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

08/31/2017

Unit of Analysis:

Household

Clusters in Final Sample:

190

Total Observations in Final Sample:

1994

Size of Treatment, Control, or Comparison Subsamples:

997 Treatment; 997 Control

Findings

Preliminary Report:

Yes

Preliminary Report URL:

http://www.ifpri.org/publication/cash-nutrition-intervention-yemen-impact-evaluation-study

Summary of Findings:

In terms of the key final outcome, child height for age, the program had insignificant impacts on average, but significnatly positive impacts on height (and weight) z-scores for children in the poorest third of households.

For the intermediate outcomes of consumption and young child feeding practices, the evaluation showed that receiving the transfers increased household food purchases by an amount equal to 63 percent of the value of the transfers.  Rather than increasing consumption of staples, households primarily used the cash transfers to buy fruits and vegetables and animal products such as milk and eggs.  The program significantly improved dietary diversity with the average number of food groups consumed by children 6-23 months increasing by 0.8 food groups.  The program also significantly increased rates of exclusive breastfeeding, early initiation of breastfeeding, and treating drinking water.   

Paper:

No

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

No--Data not expected to be available

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

No

Survey Instrument Links or Contact:

Program Files:

No

Program Files Links or Contact:

Sikandra Kurdi (s.kurdi@cgiar.org)

External Link:

http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/133205/filename/133416.pdf

External Link Description:

Policy brief summarizing findings and relevance for use of cash in humanitarian response

Description of Changes:

The intervention was temporarily suspended and expost data collection was delayed due the civil war in Yemen.

Study Stopped

Date:

Reason: