Presented by Lusajo Kajula at the Meeting on Economic Empowerment & IPV in SSA help in Johannesburg on November 8-9, 2018.

1. unite for
children
Cash transfers and gender-based violence:
The Cash Plus Study
Lusajo Kajula, Ph.D.
UNICEF Office of Research - Innocenti
Presentation at Economic Empowerment & IPV in SSA
Meeting
November 8 & 9, 2018
Johannesburg

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Social protection
Set of programs and policies that aim to reduce poverty, exclusion and vulnerability.
Contributory & non-contributory schemes, including:
• cash transfers, in-kind transfers
• waivers for schooling or health-related fees
• insurance schemes
Can be
• Protective: responding to adversity or shocks experienced by poor households
• Preventive: aiming to prevent future harm by bolstering households’ ability to cope with
future shocks such as loss of income or unexpected flooding
• Transformative: address structural barriers & aim to promote
• empowerment, voice and agency among adolescents
• tackle harmful socio-cultural practices
• improve their strategic position in families and community

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The Transfer Project
Who: Community of research, donor and implementing partners –
focus on coordination in efforts and uptake of results
 UNICEF, FAO, UNC, National Governments, National
researchers
Mission: Provide rigorous evidence on government-run large-scale
(largely unconditional) social cash transfers (SCTs)
Motivation:
 Income poverty has highly damaging impacts on human
development
 Cash empowers people living in poverty to make their own
decisions on how to improve their lives
Where: Ethiopia, Ghana, Kenya, Lesotho, Malawi,
Mozambique, South Africa, Tanzania, Zambia & Zimbabwe

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The Tanzania Social Action Fund
(TASAF)
Implemented PSSN (Productive Social Safety Net) since 2015 and it
currently reaches 1.1 million households nationally (3rd largest
government cash transfer in Africa)
•Unconditional & conditional cash transfers
•Public works
•Livelihood component
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Plus
• PSSN targets whole households w/ support for young children, in school youth &
adults (PWP)
• many adolescents, including out of school youth overlooked (60% PSSN youth
15-18 years out of school)
• Existing interventions aiming to empower adolescents often fall short: focus on
individual & ignore household poverty (structural driver of poor outcomes)
• Powerful synergies can be created when linking PSSN youth to other services &
interventions
•Key population to “break the intergenerational cycle of poverty”
•Economic empowerment alone insufficient; need to simultaneously address
SRH to reach full productive potential
Leveraging a poverty
reduction platform (PSSN)
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Cash transfers, violence & youth
Cash transfers increasingly implemented by governments to reduce poverty
• Economic drivers of GBV pathways (school drop-out, poor mental health,
early marriage, HIV risk behaviors) and violence outcomes
•Are economic strengthening programs protective?
•Key group to breaking the inter-generational cycle of poverty
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 Why doesn’t cash work the same everywhere/on all
outcomes?
Would help if we better understand pathways of impact
 Can complementary interventions and linkages to
services (Cash Plus) facilitate safer adolescent
transitions into adulthood?
Research gaps

8. unite for
children
Cash Plus: A multi-sectoral
project targeting adolescents
aged 14 – 19 years from poor
households participating and
benefiting from Tanzania Social
Action Fund’s (TASAF)
Productive Social Safety Nets
program (PSSN).
Photo: Valeria Groppo

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Cash Plus intervention
• Program components:
•The Cash: PSSN households
•The Plus:
• Livelihoods intervention (economic empowerment) to 1,250 youth
• SRH demand: Education on SRH, HIV prevention, gender
• SRH supply: Linkages to SRH, HIV and other health and violence response
services in the communities; supply-side strengthening
• Location: Mufindi and Rungwe districts
• Intervention was designed through a multi-stakeholder consultative
process
• Partners: TASAF, Tanzania AIDS Commission (TACAIDS), Ministry
of Community Development, Gender, Children & Health, UNICEF
• Implementation: district-level community development officers &
health workers for maximum capacity building and sustainability;
TASAF leading
• Addresses supply- and demand-side barriers, structural constraints

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• Livelihoods knowledge, skills, aspirations
 Economic activity
 Knowledge of and access to SRH/HIV
services
 Gender equitable attitudes
 Sexual debut, marriage and pregnancy
 Violence, exploitation victimization,
violence perpetration and transactional
sex
 Stress, mental health, hope, aspirations
and risk preferences.
Photo credit: A Kirk
Adolescent outcomes examined

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Cash Plus: Evaluation design and timeline
• March 2017 – June 2019
• Male & female adolescents aged 14-19 years
• Mufindi district (Iringa region); Rungwe District
(Mbeya Region)
• Cluster RCT design (district & village size
stratification):
•65 villages PSSN cash transfer only
•65 villages PSSN cash transfer + adolescent livelihoods
+ SRH/HIV info, with linkages to SRH services
• Baseline April – June 2017
•Community (n=130), health facility (n=91), household
(n=1946), and youth surveys (n=2458)
• Midline May – July 2018 (n=2104 in panel)
• Endline expected 2019
Photo: Lusajo Kajula

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Baseline violence0
.2.4.6.8
1
14 15 16 17 18 19
Age at baseline
Females Males
Proportion experiencing emotional or physical
violence – past 12 months
0
.2.4.6.8
1
Proportionexperiencedforcedsex-12mo
14 15 16 17 18 19
Age at baseline
Females Males
Proportion experiencing forced sexual
intercourse – past 12 months

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Aftercare
• Adolescents participated and completed intensive 12 weeks life skills,
livelihood, ASRH, HIV and GBV prevention training.
• Strategies being used include mentoring and coaching, peer
education, and linkages to adolescent friendly sexual reproductive,
HIV and GBV prevention services at the health facility level and
community level.
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Mentoring
• Matching adolescents with adult mentors who can assist them on a one-
on-one basis or in groups.
• Mentors will:
• Maintain visit mentees weekly in the first three months and then biweekly for
six months.
• Facilitate linkages to adolescent friendly sexual reproductive health, HIV
prevention and GBV treatment services through youth friendly health facilities.
• Adolescents will be:
•provided with productive grants and
•monitored how they utilize it to fund their long term plans (business ventures,
vocational skills trainings, talent development etc.)
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Peer educators & support
• The peer education initiative is supported by the fact that
adolescents are more likely to turn to their peers when they need
help.
• Peer educators have been trained to play roles of adolescent
mobilization and coordination and also act as a link between
adolescents and mentor.
• Peer educators will also link adolescents and health facilities/
extension service providers.

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Productive grant
• Focus for ages 14-17 in the aftercare will be to build confidence,
communication and building aspiration in the child, continue
education/training.
• Focus for ages 18-19 will be vocational skills or livelihood training linked
to job opportunities.
• Mentors will support adolescents to implement business plans developed
during the intensive phase period.
• A productive grant of $80 will be provided competitively, based on set
criteria (business ventures, vocational skills trainings, talents
development etc.), pending attendance minimum and business plan.

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Challenges & Innovation
• Innovations of current pilot:
•Capabilities/asset-strengthening approach: simultaneously address economic and
health assets
•Implemented within government structures: maximizing potential for sustainability
and scale-up
•Rigorous study design to study causal impacts
• Measurement/research innovations:
•Detailed information on adolescent livelihoods, schooling and economic activities
•One of few studies to measure childhood violence among males and females
within a cash transfer programme
•Innovative measures on stress, gender equitable attitudes, perception of health
worker attitudes
• Challenges:
• Highly mobile adolescent population
• Outdated government roster two years into programme
• Conducting research on a large scale PSSN program with various national
priorities and multiple contextual influences

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Despite benefiting from PSSN program, youth still face a number of
challenges, driven by poverty
Labor-constrained households
Shocks and negative coping strategies
Youth-level:
School drop-out
Lack of access to markets
Depression
Violence
Poor perceived quality of life
Randomization was successful; study design internally valid
Intervention is well targeted:
High aspirations
Low rates of sexual debut at baseline; expect to observe transitions over
study period (24 months)
Conclusions

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• Transfer Project website: www.cpc.unc.edu/projects/transfer
• Briefs: http://www.cpc.unc.edu/projects/transfer/publications/briefs
• Facebook: https://www.facebook.com/TransferProject
• Twitter: @TransferProjct
• Email: lkajula@unicef.org
For more information
Ghana, credit: Ivan Griffi
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References
• Baird, S., et al. (2014). "Conditional, unconditional and everything in between: a systematic review of the effects of
cash transfer programmes on schooling outcomes." Journal of Development Effectiveness 6(1): 1-43.
• Cluver, L., Boyes, M., Orkin, M., Pantelic, M., Molwena, T., & Sherr, L. (2013). Child-focused state cash transfers
and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. The Lancet
Global Health, 1(6), e362-e370.
• Dake, F., Natali, L., Angeles, G., De Hoop, J., Handa, S., & Peterman, A. (2018). Income transfers, early marriage
and fertility in Malawi and Zambia. Studies in family planning, in press.
• Handa, S., Halpern, C. T., Pettifor, A., & Thirumurthy, H. (2014). The government of Kenya's cash transfer program
reduces the risk of sexual debut among young people age 15-25. PLoS One, 9(1), e85473-e85473.
• Handa, S., Peterman, A., Huang, C., Halpern, C. T., Pettifor, A., & Thirumurthy, H. (2015). Impact of the Kenya Cash
Transfer for Orphans and Vulnerable Children on Early Pregnancy and Marriage of Adolescent Girls. Social Science
& Medicine, 141, 36-45.
• Heinrich, C. J., Hoddinott, J., & Samson, M. (2017). Reducing adolescent risky behaviors in a high-risk context: the
effects of unconditional cash transfers in South Africa. Economic Development and Cultural Change, 65(4), 619-652.
• Kilburn, K., Thirumurthy, H., Tucker Halpern, C., Pettifor, A., & Handa, S. (2016). Effects of a large-scale
unconditional cash transfer program on mental health outcomes of young people in Kenya: a cluster randomized
trial. Journal of Adolescent Health, 58(2), 223-229.
• Pettifor, A., et al. (2016). "The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN
068): a phase 3, randomised controlled trial." The Lancet Global Health 4(12): e978-e988.

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Acknowledgments & Evaluation Team
Evaluation Team: Evaluation Team:
UNICEF Office of Research: Tia Palermo (co-Principal Investigator), Lusajo Kajula, Jacob de Hoop,
Leah Prencipe, Valeria Groppo
EDI: Johanna Choumert Nkolo (co-Principal Investigator), Respichius Mitti (co-Principal Investigator),
Nathan Sivewright, Koen Leuveld, Bhoke Munanka
TASAF: Paul Luchemba, Tumpe Lukongo
TACAIDS: Aroldia Mulokozi, Jumanne Issango
UNICEF Tanzania: Ulrike Gilbert, Paul Quarles van Ufford, Rikke Le Kirkegaard, Frank Eetaama
The evaluation team would like to acknowledge the support of the TASAF and TACAIDS, in particular
Ladislaus Mwamanga (TASAF), Amadeus Kamagenge (TASAF), and Mishael Fariji (TASAF) for the
implementation of this evaluation. In addition, the UNICEF personnel instrumental to the initial
planning stages of this pilot and study include: Beatrice Targa, Patricia Lim Ah Ken, Victoria Chuwa,
Naomi Neijhoft and Tulanoga Matwimbi. Funding for this evaluation has generously been provided by
Oak Foundation; UNICEF Tanzania; and Sida, through a grant to UNICEF Office of Research—
Innocenti supporting the Transfer Project.
We would also like to acknowledge the hard-working field teams of EDI, who conducted the data
collection for this study to the highest professional standards.

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•Ahsanteni!