Cash transfers in Yemen led to significant improvements in nutrition. Households spent more on non-staple foods like milk, fruits, and vegetables. This improved dietary diversity for young children and women. Cash transfers also increased beneficial practices like early initiation of breastfeeding and treating water. Children experienced less malnutrition and higher anthropometric scores for weight and height. The program shows cash transfers can effectively deliver aid and promote nutrition in humanitarian contexts.

1. Impact Evaluation of
Cash for Nutrition
Sikandra Kurdi
Development Strategy and Governance Division
International Food Policy Research Institute
Washington, DC | September 5, 2019

2.  Conflict is now a major driver of food insecurity globally
 Cash transfers are becoming increasingly popular mode of aid
delivery in humanitarian contexts where markets are functional
such as in situations of protracted conflict
oLess expensive and usually preferred by beneficiaries
oMay be more beneficial for nutrition than in-kind food aid
 Lack of rigorous evidence on impacts on nutrition because of the
difficulty of conducting research in humanitarian settings
Motivation

3.  Cluster Randomized Control Trial at village level designed for evaluation of the pilot program
o 2,000 households in 190 towns and villages in 3 districts in Al Hodeidah
o Randomization mostly maintained by inertia during program resumption in the ECRP
o 93% of households assigned to treatment and 24% of households assigned to control self-report
being treated at expost
o Impact estimates based on self-reported treatment status with assignment as instrumental variable
Methodology
Baseline
2015
Jan
.
Apr Jul Oct
2016
Jan Apr Jul Oct
2017
Jan Apr Jul
Follow-up
Conflict
Pilot intervention ECRP expanded
intervention

4.  Increased household purchases in cash by 1000
riyals per week (63% of the transfer value)
 Significant impacts of the cash transfers on
increasing consumption on non-staple food items
o Including milk, fruits and vegetables, and eggs
o Strongest impact on poorest tercile of
households
o 48% of the transfer value spent on 33 listed
non-staples in survey
 No impacts on staple calorie consumption
(increased for all households between baseline and
expost)
 No impacts on prices or availability of foods at
market
Consumption

5.  Large and significant impact on young child dietary diversity (6-23 months)
o Increase of 0.8 food groups per day (4 is minimally acceptable diet)
 Significant but smaller in magnitude impact on women’s dietary diversity
Dietary Diversity
0 0.5 1 1.5 2 2.5 3 3.5
Baseline (Pre-Conflict, January 2015)
Follow-up (Ongoing conflict, August 2017)
Child dietary diversity scores
Food groups (out of 7) consumed in past 24 hours for children ages 6-23
months
Control Treatment

6.  Significant impact on self-reported practices:
oRate of early initiation of breastfeeding up by 15 percentage
points compared to 74% in control group at follow-up
oRate of exclusive breastfeeding up by 15 percentage points
compared to 14% in control group at follow-up
oRate of treating water for drinking (mostly by boiling or filtering)
up by 17 percentage points for adults and 10 percentage points
for children under 2
Sanitation and Breastfeeding Practices

7.  Decreased rate of children under 5 reported as having been diagnosed with
malnutrition at health center in past 2 years by 10 percentage points
o Relative to increase between baseline and follow-up of 13 percentage points
o Also decreased rate of children diagnosed with severe acute malnutrition by 5
percentage points
 Significant increases on anthropometrics for poorest tercile of households
o 0.43 in weight-for-age z-scores (WHZ) (measure of short-term nutritional
deficiency
o 0.35 in height-for-age z-scores (HAZ) (measure of long-term nutritional
deficiency)
o For children between 7 and 30 months of age at the time of the baseline
survey who were measured again at follow-up
Child Nutrition Outcomes

8. Other Coping Strategies
29.3%
48.2%
74.3%
14.4%
30.2%
17.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Repaying debt to
neighbors/ relatives
Repaying debt to
shopkeeper
Buying more food Buying better quality
food
Paying for healthcare Other
How Households Used Transfers
(multiple responses allowed)
Cash transfers allowed households able to make non-food purchases without
drawing down their assets, increasing their future resilience
Significant decrease in share of households reporting coping with shocks by:
• Selling gold
• Borrowing from neighbors

9.  High attendance at the nutritional training sessions even by non-recipients
of the cash transfers
o 13% of control households in our sample who did not self-report as part
of the CCT program still attended nutritional training sessions
o 26% of control households who did not self-report as part of the CCT
program still reported learning something new from the community
health educator
o Significant increases between baseline and expost among non-CCT
participants in water treatment; knowledge about health center location;
knowledge about iron-rich foods for preventing anemia; and knowledge
about exclusive breastfeeding
Effectiveness of Soft Conditionality