Uganda Case Study: An Impact Evaluation of Cash and Food Transfers at Early Childhood Development Centers in Karamoja. Page 1

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1 Uganda Case Study: An Impact Evaluation of Cash and Food Transfers at Early Childhood Development Centers in Karamoja Page 1

2 Uganda vs. Ecuador Similarities to Ecuador case study: RCT rigorously comparing alternative modalities to food assistance Attempt to keep all features of treatment arms identical except modality Same household dietary diversity measures studied Costing analysis underway Page 2

3 Uganda vs. Ecuador Differences from Ecuador context: Food vs. cash vs. control (no voucher, infeasible in Karamoja) Food transfers consist primarily of an item not regularly available in markets (Corn Soya Blend) Beneficiaries baseline food consumption was very limited, malnutrition was high Rural setting Beneficiaries were cash-strapped, markets were available but not well-developed Transfers conditioned on preschool enrollment Transfers targeted specifically to a preschool-age child (rather than to household broadly) Focus on child outcomes Page 3

4 Uganda case study: Impact Evaluation of Transfers Linked to Preschool Enrollment In 2010, IFPRI joined WFP and UNICEF to study the impact of food or cash transfers linked to children s preschool enrollment in Karamoja, Uganda Measure impacts on Household food security Child diet quality Child health and development Page 4

5 Background and motivation Part of a multi-country WFP study rigorously comparing alternative modalities to food assistance across diverse contexts Set in a high-poverty rural area in Sub-Saharan Africa Contributes to limited evidence on what kind of interventions improve early childhood development (ECD) ECD increasingly recognized as critical: for school-readiness in short term, for education and labor market outcomes in long term Micronutrient deficiency and inadequate stimulation are major causes of impaired child development in poor countries Transfers linked to preschool could improve both diet (nutrition) and preschool participation (stimulation) we rigorously compare transfer modalities Page 5

6 In Karamoja since 2007 Very informal, usually under a tree Volunteer caregivers trained by UNICEF Community supposed to contribute, rarely did at baseline Target age: 3-5 years ECD Centers in Karamoja Page 6

7 The WFP Food and Cash Transfers WFP study linked transfers to ECD enrollment per RCT design 98 ECD centers were randomly assigned to food, cash, or control One transfer per eligible child (age 3-5 years, enrolled in ECD center) Seven 6-week cycles, starting in April 2011 Food transfers: 1200 calories per child per day Multiple-micronutrient fortified corn soy blend (99% of iron requirements), Vitamin A fortified oil, sugar Cash transfers: Cash equivalent: ~$12 per 6-week cycle Added electronically to a card, retrieved from mobile money agent Page 7

8 RCT Evaluation Design Random assignment of communities into food, cash and control groups assures that the ECD centers, households and children are similar on average, at baseline implies differences in average outcomes at endline between treatment groups must be caused by the program Page 8

9 Data: Panel survey of households with at least one ECD-enrolled child aged 3-5 years at baseline Baseline survey (2010) and endline survey (2012) measured household food security, child nutrition, cognitive development 2449 household interviews, 5157 child assessments Balancing tests and attrition analysis confirm treatment arms are very similar on average at baseline Impacts estimated using single-difference (robustness checks with ANCOVA) Focus impact estimates on children 3-5 years throughout: months (3 to 4.5 years) at baseline, months (4.5 to 5 years) at endline Page 9

10 Measures of Household Food Security Dietary Diversity Index (DDI): number of food groups from which any food was consumed (0 to 46) Household Dietary Diversity Score (HDDS): aggregates foods into 13 groups and counts the number of food groups from which any food was consumed (0 to 13) e.g.: cereals, roots/tubers, meat/poultry, milk/dairy, oils/fats Food Consumption Score (FCS): a weighted sum of the number of days in the last 7 days that food was consumed across 9 food categories captures dietary diversity and frequency of food consumption FCS is used by WFP to measure food security in many countries Page 10

11 Measures of Household Food Security Components of the Food Consumption Score Group Food items Food group Weight 1 Maize, maize porridge, rice, sorghum, millet past, bread and other cereals Staples 2 Cassava, potatoes and sweet potatoes, other tubers, plantains 2 Beans, peas, groundnuts and cashew nuts Pulses 3 3 Vegetables, leaves Vegetables 1 4 Fruits Fruit 1 5 Beef, goat, poultry, pork, eggs, and fish Meat and fish 4 6 Milk, yogurt, and other dairies Milk 4 7 Sugar, sugar products, and honey Sugar Oils, fats, and butter Oil Corn soya blend CSB 4 Source: Based on WFP (2008) and modified to account for CSB. Page 11

12 Cash (not food) improves measures of household food security, increasing dietary diversity Cash transfers improved 2 out of 3 measures Food transfers had no impact Results suggest it was easier to use cash to diversify diets ** *** % Food v control 4.0 Cash v control DDI HDDS FCS Page 12

13 Days per Week Cash (not food) improves frequency of consumption of starches, meat and dairy in target children *** 0.51*** * Food v Control Cash v Control Cash effects are large: Frequency rose 66% for meat, 100% for dairy In food households, 44% say ration eaten by all members possibly limited share to target child Page 13

14 Cash significantly reduces anemia, while food has no significant impact 4% 2% 0% -2% 1.7% 1.2% % -4% -6% -8% Food v Control Cash v Control -10% -12% -10.0% * -9.6% ** Any anemia Moderate/severe BIC: 4.5 to 5 years Consistent with diet quality impacts Anemia prevalence high in control group: 42.9% have anemia, 24.5% have moderate/severe anemia Page 14

15 Cash significantly increases ECD centers operation and children s attendance, while food has no significant impacts Cash households report more contributions to ECD center caregiver and better infrastructure May have led to ECD center being open and children attending more often D a y s *** Days open in past 7 days *** Days attended in past 7 days Food v Control Cash v Control BIC: 4.5 to 5 years Page 15

16 Cognitive development measures Measured through simple games with child by trained enumerator Cognitive items drawn from Mullen Scales of Early Learning Adapted for Karamoja by a clinical psychologist at Makerere University Domains: Visual reception Fine motor Receptive language Expressive language Page 16

17 Cash significantly increases cognitive development measures, while food decreases some domain scores ** 11.6 ** 11.6 *** 9.0 *** % * *** -4.3 Food v Control Cash v Control -15 Visual reception Fine motor Receptive language Expressive language TOTAL Cognitive BIC: 4.5 to 5 years Page 17

18 Implications: Impacts of cash transfers linked to preschool Consistent evidence of significant improvements from cash transfers linked to ECD center participation for children age 3-5 years during the study period on... household food security child health and development improved diet quality (more meat/eggs and dairy) reduced anemia increased ECD center participation improved cognitive development Suggests pathways for effects on cognitive development Nutrition: improved diet quality helped to improve iron status better cognitive outcomes Stimulation: more cash contributions to caregivers improved quantity/quality of ECD participation better cognitive outcomes Page 18

19 Understanding the Impacts of Food Transfers Why were impacts of food transfers limited relative to cash? Food rations shared: 44% say rations eaten by all household members CSB not highly valued: 54% report preferring maize flour, potentially difficult to use as a contribution to ECD center caregiver CSB not regularly sold in markets: potentially hard to sell for cash Cash-strapped communities: cash very valuable, while food rations available through other programs Possible targeting issues: some food beneficiaries initially left off beneficiary lists? Page 19

20 Broader findings from comparison of Ecuador and Uganda In both Ecuador and Uganda Households that receive food appear not to sell it Households that receive cash appear to use it to purchase food and improve dietary diversity In Ecuador: increases consumption of roots/tubers, vegetables, meat/poultry, eggs, fish/seafood, legumes, milk/dairy In Uganda: increases consumption of starches, meat/eggs, and dairy But in different contexts, impacts of modalities differ Food had significant positive impacts on food security measures in Ecuador, while it did not in Uganda In Niger, preliminary evidence indicates food has larger impacts than cash on food security and dietary diversity Page 20

21 Broader findings from comparison of Ecuador and Uganda Preliminary observations Baseline characteristics of beneficiaries may matter Market structure may matter Type of food ration may matter Relative preference for quality of food vs. quantity of food differs by income? At higher income, prefer to increase quality rather than quantity At lower income, prefer to increase quantity rather than quality Consistent with pattern in beneficiary characteristics across Ecuador (poor), Uganda (very poor), and Niger (extremely poor) Page 21

22 Costing Analysis Page 22

23 Costing analysis: Overview Why conduct cost analysis? Allows for the examination of which program modality (cash, voucher, or food) provides the greatest benefit for the amount of funds invested Research questions: What are the relative costs of each modality (cash, voucher, food)? Which modality is the most cost-effective?

24 Costing analysis: Overview Method: Activity Based Costing-Ingredients (ABC-I) Identifies all activities under each modality and then identifies, quantifies and costs all of the inputs (human and physical) required to produce each of those activities. Collected detailed information on program costs Employee time allocation matrices Program documents and budgets Interviews and discussions with partners and program staff Page 24

25 Assumptions/criteria: Costing analysis: Assumptions Only include costs to WFP and not costs to outside institutions or beneficiaries Full cost of food = market price = value of cash transfer (per program design) Variance in the cost of food over time was not included in this analysis Measure an estimate of average cost; assume average cost is a constant Page 25

26 Costing Analysis: Ecuador Separate out costs in the following ways: Costs that are incurred irrespective of the modality chosen. These include planning costs, targeting, sensitization, nutrition training Costs that are unique to the modality (modality specific) FOOD CASH VOUCHER Non-modality specific $14.43 $11.74 $11.06 Modality-specific $11.50 $3.03 $3.30 Total cost per transfer $25.93 $14.77 $14.36 Total cost per beneficiary $ $88.62 $86.17 Principal cost specific to modality Storage; ration preparation Debit cards Design, liquidation of vouchers Page 26

27 Costing Analysis: Ecuador Cost effectiveness Cost of improving outcomes by 15% using modality specific costs FOOD CASH VOUCHER Consumption $10.78 $3.79 $3.81 Calories $10.78 $7.58 $4.50 HDDS $28.75 $11.36 $8.25 DDI $15.68 $3.25 $2.91 FCS $17.25 $4.13 $3.09 Page 27

28 Ecuador Costing Analysis: Summary of findings Cash and vouchers are the cheapest ways to deliver a transfer However, vouchers provide the most cost-effective means of improving dietary quantity and quality Food is the least cost-effective way to improve the quality and quantity of food consumption Page 28

29 Uganda costs (preliminary) Cash * Food ** Total cost per beneficiary $98.22 $96.11 Total cost per transfer $14.03 $13.73 Primary costs specific to modality Transaction fees Food distribution/ transport *Cash modality includes certain start-up costs not incurred by food ** Food modality currently underestimates cost of Landside Transport Storage & Handling (LTSH)

30 Uganda Costing Analysis: Summary of findings Preliminary cost estimates for Uganda indicate cash linked to preschool is more cost-effective than food linked to preschool for both household food security and child outcomes Refining estimates will only increase relative cost of food, adjusting for: Start-up costs incurred only for cash (food is ongoing modality for WFP) LTSH costs reflecting total (vs. marginal) cost of food distribution Page 30

31 Implications for relative cost-effectiveness In both Ecuador and Uganda modalities other than food were more cost-effective than food in improving food security (for both household and child) However, as with relative impacts, relative cost-effectiveness is likely to differ by context Page 31

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