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Study Overview

Impact Evaluation of the Integrated Safety Net Program in Amhara Region
Study is 3ie funded:
Study ID:
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Last Update Date:
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The aim of this study is to examine the impacts of a social protection program -the Integrated Safety Net Program (ISNP)- in Amhara, Ethiopia, on the well-being of households. The main objective of this pilot program is to facilitate linkages between households participating in the existing Productive Safety Net Programme (PSNP) and other existing services, with a particular emphasis on enrolment into community based health insurance (CBHI). This evaluation compares PSNP households who receive the integrated component (“the plus”) with households who are enrolled in the PSNP but who only receive the cash (the comparison group), to rigorously identify impacts of the integrated (ie, “plus”) programming among PSNP households. The integrated component includes behaviour change communication (BCC) on nutrition, health, child marriage, gender, and adolescent sexual and reproductive health (SRH); facilitation of enrolment into the CBHI and exempting certain beneficiaries of the PSNP from paying the enrolment premium; and case management by social welfare workers to support linkages between PSNP clients and health and social services.
Registration Citation:
Health, Nutrition, and Population
Social Protection
Additional Keywords:
Health insurance, health seeking behavior, child marriage,
Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:
Tia Palermo
UNICEF Office of Research
Name of Second PI:
Frank Otchere
UNICEF Office of Research

Study Sponsor

Study Sponsor Location:

Research Partner

Name of Partner Institution:
BDS Center for Development Research
Type of Organization:
Private firm

Intervention Overview

The intervention (“The Integrated Safety Net Programme (INSP)”) consists of a pilot program which facilitates linkages between households participating in the existing Ethiopian Productive Safety Net Programme (PSNP) and other existing services, with a particular emphasis on enrolment into community based health insurance (CBHI). The PSNP is a nationwide social protection program which has been in place since 2005 and reaches more than 10 percent of households in rural Ethiopia. The integrated service package includes a comprehensive case management system, which links PSNP clients to basic social and health services, and allocates certain co-responsibilities related to basic health and nutrition services to certain clients of the PSNP (The Direct Support clients). These clients include Pregnant and Lactating Women and caretakers of malnourished children. The pilot will exempt a group of client beneficiaries (the Direct Support clients) from paying the CBHI premium, and will further provide information on CBHI enrolment to PSNP clients in the Public Works Programme (PWP) (another group of clients), though the latter will still be required to pay the premium.
Theory of Change:
It is hypothesized that the ISNP will strengthen four types of assets among households: economic capital, social capital, education capital, and health capital. Economic capital is expected to increase due to the cash transfers, productive impacts of the cash transfers, and potentially a reduction in out-of-pocket health expenditures due to enrolment in the CBHI. Social capital can expand through participation in Behavioral Change Communication (BCC) sessions and support from the social workers and Community Care Coalitions (CCC). Education capital can improve through attendance at BCC and support by social workers and CCC (for caregivers), and through increased school attendance (for children). Finally, health capital is expected to improve due to enrolment in the CBHI and due to improved practices regarding nutrition, health and sanitation as a result of the BCC sessions.
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
UNICEF and Government of Ethiopia
Type of Organization:
Foreign or Multilateral Aid Agency

Program Funder

Name of Organization:
UNICEF (with the generous support of SIDA funding)
Type of Organization:
Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?
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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Difference in difference/fixed effects
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:
This evaluation is based on a prospective quasi-experimental differences-in-differences (DID) design. This DID design estimates impact by comparing changes in the ISNP program areas between the 2018 baseline and 2020 endline to changes occurring in the comparison (PSNP only) areas over the same period of time, controlling for differences between the treatment and comparison groups with respect to household and community characteristics. We will analyse the impacts of the integrated component (the “Plus”) and not of the cash, as both “treated” and “control” groups are recipients of the PSNP. A randomized control trial was not possible, as communities could not be randomized into treatment arms for the “plus” components. To address the issue of selection bias, we will use a matching estimator. The estimator we will utilize for the current study is the doubly-robust inverse-probability-weighted regression-adjustment (IPWRA). To complement the quantitative analysis, we will collect and analyse qualitative data to better identify pathways of impacts.
Outcomes (Endpoints):
Key outcomes to be measured include economic productivity; health and nutrition; knowledge of and access to health, child protection, and other services; expenditure on education and health; violence victimization and perpetration; school attendance, hope, future aspirations; mental health; risk preferences; women’s empowerment and intra-household distribution and bargaining. There will also be a module on marriage that will collect information on women under 25 years of age.
Unit of Analysis:
Unit of Intervention or Assignment:
Number of Clusters in Sample:
Number of Individuals in Sample:
5537 households
Size of Treatment, Control, or Comparison Subsamples:
Treatment subsample: 2760; Control subsample: 2777

Supplementary Files

Analysis Plan:
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Outcomes Data

Household surveys will be administered to one female in each household (priority given to the caregiver of children), or male primary caregiver of child when female cannot be located. There will also be a module on marriage asking about women ages 12-24 years of age, including those who have lived in the household within the past 5 years (even if no longer currently living in household), answered by the main respondent/household head, and a specific module for pregnant women.
Data Already Collected?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Treatment Assignment Data

Participation or Assignment Information:
Data Obtained by the Study Researchers?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Data Analysis

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Study Materials

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Registration Category

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

Completion Overview

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Unit of Analysis:
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Preliminary Report:
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Summary of Findings:
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Data Availability

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Other Materials

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Description of Changes:

Study Stopped