Tanzania’s “Unjana Salama” Adolescent Cash Plus Program
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This document summarizes a study on the Ujana Salama cash plus intervention in Tanzania. The intervention provided adolescent youth in Tanzania with livelihoods training, productive grants, mentorship, and referrals to health services alongside an existing cash transfer program. A mixed-methods cluster randomized controlled trial found the intervention had positive impacts on economic opportunities, mental health, gender attitudes, and health knowledge and behaviors up to 2 years post-intervention. These findings suggest cash transfers can be enhanced by linking youth to complementary services to promote multidimensional well-being when transitioning to adulthood.
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Tanzania’s “Unjana Salama” Adolescent Cash Plus Program
- 1. Ujana Salama: A Cash Plus Model for Youth Well-being And Safe, Healthy and Productive Transition to Adulthood as part of Tanzania’s Productive Social Safety Net Programme (PSSN) Tumpe Mnyawami Lukongo, Tanzania Social Action Fund (TASAF) Tia Palermo, University at Buffalo & PRESTO on behalf of the Tanzania Adolescent Cash Plus Evaluation Team
- 2. Tanzanian Context •Youth population (15-34 years) expected to increase from 16.7 million (2015) to 30.3 million (2025) Adolescence a unique window of opportunity. Investments a “triple dividend”. Adolescents face many risks related to poverty, early pregnancy and marriage, violence, HIV, and lack of livelihood opportunities. Social protection can mitigate some gendered risks and expand future opportunities if designed to be gender transformative.
- 3. Overview of PSSN Program • Government institution launched in 2000 • Implements Productive Social Safety Net since 2012 • Aim: to reduce poverty and advance social protection agenda • First two phases focused on improving social services and infrastructure Tanzania Social Action Fund (TASAF) • Aimed to increase income and consumption and improve the ability to cope with shocks, while enhancing and protecting the human capital of their children • Targets poor & vulnerable households Productive Social Safety Net (PSSN I; 2012-2019) • Aims to improve access to income-earning opportunities and socioeconomic services; enhance and protect the human capital of children • National scale (17,260 villages/Mitaa/Shehia in Mainland and Zanzibar) • Reached 1.3 million households with 5.4 million beneficiaries PSSN II (2020- Present)
- 4. PSSN has the following major components: 1. Cash Transfer (UCT & CCT) 2. Labour Intensive Public Works 3. Livelihood Enhancement 4. Targeted Infrastructure Development 5. Institution strengthening
- 5. PSSN Youth Study (2015-2017) • RCT examining impacts of PSSN on adolescent and youth well-being • PSSN has positive impacts on basic needs, social support, decision-making school attendance & attainment • Children simultaneously increased work within the household; & school attendance • Cash is important, but not sufficient to address all barriers to safe and productive transitions to adulthood • Powerful synergies can be created when linking adolescents in PSSN households to other services and interventions
- 6. Ujana Salama: A Cash Plus Model For Safe Transitions To A Healthy And Productive Adulthood Study (2017-2021)
- 7. Intervention Livelihoods and life skills training (12 weeks) Productive Grant (80 USD) Mentorship & coaching (9 months) Referral to strengthened, adolescent friendly health services Implemented within Government’s Productive Social Safety Net (PSSN) – livelihoods component
- 8. Sample Topics Livelihoods • Transformation • Dream • Business concepts • Generate business idea • SWOT analysis • Developing a business plan • Role of family & community • Record keeping • Saving for business • Responsibilities of entrepreneur Sexual & Reproductive Health • Relationships • HIV & AIDS • Puberty • Sexual risk-taking & protection • Gender-based violence’ • Visit health center • Family planning • Alcohol & drug abuse
- 10. for every child, answers Study Design: Mixed Method Cluster RCT • 130 villages (clusters) in four districts/ randomized into: • Treatment: Cash+ adolescent-focused training and services layered onto PSSN • Control: Cash (PSSN) only Design • 2,191 youth (14-19 years old at baseline) from 1,717 households Study sample • 2017, 2018, 2019, 2020 (remote), 2021 Data collection • Youth; Households; Communities; Health facilities (quantitative and qualitative) Surveys • Intent to treat; ANCOVA models on panel sample Analysis
- 11. Overview of Findings Notes: • ↓ indicates decrease in the outcome • ↑ indicates an increase in the outcome • Black Pooled sample • Purple females • Green males • Empty box indicates no (null) impact unless otherwise specified Domain Indicator Round Two Round Three Round Four Education and livelihoods Participation in economic activities ↑↑ ↑↑ Has business in operation Not measured ↑↑↑ ↑↑ Livestock herding ↑↑↑ ↑↑ ↑↑ Participation in household chores ↑ ↑ Attends school ↓↓ Mental health and attitudes Self-esteem or locus of control ↑↑ Depressive symptoms ↓↓↓ ↑ Health seeking and knowledge HIV knowledge ↑↑ ↑↑ HIV testing ↑↑ Contraceptive knowledge ↑↑ ↑↑ Contraceptive use SRH care seeking ↑ ↑ Sexual risk behaviours Sexual debut Transactional sex Gender attitudes Gender-equitable attitudes ↑↑ ↑↑ Violence Experienced violence ↓↓↓ ↓↓ Not measured
- 12. What about gender? SRH = sexual & reproductive health Impacts driven by females • Livestock herding • Farmwork for household • Sexual violence experience • Self-esteem • Entrepreneurial attitudes • Schooling • Contraceptive knowledge Impacts driven by males • Gender equitable attitudes • Violence perpetration • Emotional violence experience • HIV testing • Sought SRH services Impacts similar • Started business • Business in operation • Purchased livestock • Discussed contraception with provider • Mental health
- 13. Cash Plus Impacts: Round 3 (end of 18-month intervention) HIV testing (NS) Condom use (NS) Sexual Violence (↓ 53.3%) Gender Attitudes (↑ 12.7%) Attending school (↓ 10.3%) Livestock Herding (↑ 13.1%) Operating a business (↑ 151%) Depressive symptoms (↓ 24.5%) Productive grant & mentoring Youth- friendly Health Services Livelihood& life skills Training ↓ 3 pp Modern Contraceptive Knowledge (↑ 4.4%) pp: percentage point NS: not significant Accessed SRH services (NS) HIV knowledge (↑ 7.5%)
- 14. Cash Plus Impacts: Round 4 (22 months post- intervention) HIV testing (NS) Condom use (NS) Gender Attitudes (NS) Attending school (NS) Livestock Herding (↑ 20.9%) Operating a business (↑ 88.3%) Depressive symptoms (↑ 23.8%) Productive grant & mentoring Youth- friendly Health Services Livelihood& life skills Training ↓ 3 pp Modern Contraceptive Knowledge NS pp: percentage point NS: not significant Accessed SRH services (NS) HIV knowledge (NS) Sexual Violence (NS)
- 15. YOUTH Participant quote I continued staying at home (after completing Standard 7) trying to find my life by different means, hustling just like that, until TASAF called us and started entrepreneurship training for us. They taught us and gave us projects and that’s what we’re doing. As I continue, I say after I finish here (vocational training) I will start my tailoring business and continue to hustle with life.
- 16. What about context? Intervention had larger effects on SRH health-seeking & HIV testing in villages where health facilities were of low quality.
- 17. Conclusions Conclusions Intervention took an “enhancing capabilities” approach, recognizing joint importance of health and economic capabilities Study contributes to evidence on how social protection can address multidimensional poverty and link to other sectors & leverage existing services Positive, sustained impacts on economic activities, business in operation, livestock herding, health seeking and reductions in violence • Suggests resiliency has been strengthened Findings suggest that linkages around health services & vocational training, apprenticeship opportunities should be further strengthened Some impacts were not sustained 1.5 years after the intervention ended • But household experienced cash transfer payments delays & COVID-19 caused health & economic shocks • Hard to know whether due to intervention design or if it was just not sufficient to overcome major shocks Subsequently scaled up in control villages & 7 additional districts in Songwe & Kagera regions
- 18. Conclusions Conclusions: Implementation aspects for success Embedded in government PSSN programme with strong ownership from onset Enhancing capabilities framework for adolescent development to develop economic, social and health assets Good community involvement with male and female mentors and peer educators selected from the local community Included mentorship phase by trusted and trained adults from the local community Gender-sensitive design paid attention to local context and different needs of girls and boys Addressed linkage to health services
- 19. Tanzania Adolescent Cash Plus Evaluation Team UNICEF Office of Research - Innocenti: Valeria Groppo, Hassan Kihanzah, Lusajo Kajula (qualitative co-PI), Graca Marwerwe, Rosemarie Mwaipopo, Leah Prencipe, Nyasha Tirivayi, Jennifer Waidler; University at Buffalo: Tia Palermo (co-Principal Investigator), Sarah Quinones; UNICEF Tanzania: Ulrike Gilbert, Paul Quarles van Ufford, Rikke Le Kirkegaard, Frank Eetaama, Jennifer Matafu; Luisa Natali, Diego Angemi; EDI Global: Johanna Choumert Nkolo (co-Principal Investigator), Respichius Mitti (co-Principal Investigator), Bhoke Munanka; TASAF: Paul Luchemba, Tumpe Mnyawami Lukongo; TACAIDS: Aroldia Mulokozi
- 20. Funding partners ● Oak Foundation ● FCDO (Round 4) under Gender Responsive and Age Sensitive Social Protection (GRASSP) Initiative ● DFID (Rounds 1-3) ● Sida ● Irish Aid ● UNICEF Tanzania
- 21. Stay Tuned For More Cash Plus in Tanzania Stawisha Maisha “Nourishing Life” Intervention to reduce Child Malnutrition & Impact Evaluation rolling out at scale in 2023
- 22. Thank you Tumpe Mnyawami Lukongo Research & Evaluation Tanzania Social Action Fund (TASAF) tumpe.lukongo@tasaf.go.tz Tia Palermo Associate Professor University at Buffalo tiapaler@buffalo.edu
Editor's Notes
- When explaining this slide, you can mention that (i) challenges differ between rural vs urban, and (ii) that the Tanzanian context can have similar challenges to other African countries (external validity). During adolescence, intense physical and emotional transformations occur. Adolescence is posited to represent a unique window of opportunity, and investments in adolescence are often referred to as having a “triple dividend”. That is because investments in adolescence incur today, in adolescents’ future adult life, and in the next generation of children. Females in Tanzania are at a higher risk than males of contracting HIV. In fact, Tanzanian women aged 20-29 years old are more than twice as likely to be living with HIV than their males counterparts (9). Child marriage and early pregnancy, outcomes which restrict future opportunities, are also common in Tanzania: one girl in three is married before age 18, and 43 per cent of females ages 20–24 gave birth before age 18 (7). Moreover, while other countries in the region have made progress in reducing child marriage, child marriage rates in Tanzania have remained stagnant over the past 10 years (10).
- implemented in all Local Government Authorities in Tanzania
- PSSN I started 2012 ended September 2020 PSSN II were launched in 2020 and is covering all the villages in Tanzania.
- IE was (led by UNICEF and REPOA) Motivated by understanding that adolescents are key population to break the intergenerational cycle of poverty
- Adolescent girls and boys 14-19 years old Living in households supported by the Productive Social Safety Net (PSSN) Cash plus implemented through Government program- PSSN, Started as pilot in 4 Districts; now scaled to additional districts
- This study was a cluster randomized control trial in 130 villages. We followed 2,191 between 2017 and 2018, including 904 youth in the violence split-sample. 48% of total eligible (n=1063) participated in the trainings.
- This study was a cluster randomized control trial in 130 villages. We followed 2,191 between 2017 and 2018, including 904 youth in the violence split-sample. 48% of total eligible (n=1063) participated in the trainings.
- Caveats for interpretation: PSSN payment delays after March 2019 Wide net of outcomes; significant programme impacts on all outcomes not expected Timing of intervention components There was an observed decrease in secondary school attendance. This result is driven by dropout from secondary school in the subsample of females. Compared to males, females were more likely to be in secondary school at baseline, before the start of the intervention. Females also had a higher participation rate in the Cash Plus training programme. These factors may have contributed to the observed effects for female. Most dropouts happened prior to receipt of the productive grant. This suggests that payment of the grant did not lead to dropout, but that it was possible youth may have decided to leave school during or in the months after the face-to-face the training, in expectation of the productive grant and/or earnings from business. As reflected in qualitative interviews, several factors may have contributed to this decision, including financial barriers to education, lack of vocational training facilities available locally, as well as low perceived returns to schooling and lack of job opportunities for educated youth in study communities. Overall the aforementioned schooling findings are not surprising, given the business development focus of the livelihoods training. In fact, more youth submitted a business plan than an educational plan, especially among dropouts. Don’t read (Just FYI for Q&A): Started a new business: .181 pp impact Business in operation: 0.159 pp Purchased livestock: 0.122 pp Self-esteem: 0.90 on scale 1-5 Entrepreneurial attitude 0.20 on scale 0-1 Reports CES-D>-10: -0.065 pp (0.172 pp ATT) Dropped out secondary: 0.059 Current attendance (all): -.0.036 Females attending secondary: -0.070 Dropped out secondary: 0.071 28 T (15 received training) females v. 17 C females dropped out (Between R2 and R3: 12 v. 8)
- Caveats for interpretation: PSSN payment delays after March 2019 Wide net of outcomes; significant programme impacts on all outcomes not expected Timing of intervention components There was an observed decrease in secondary school attendance. This result is driven by dropout from secondary school in the subsample of females. Compared to males, females were more likely to be in secondary school at baseline, before the start of the intervention. Females also had a higher participation rate in the Cash Plus training programme. These factors may have contributed to the observed effects for female. Most dropouts happened prior to receipt of the productive grant. This suggests that payment of the grant did not lead to dropout, but that it was possible youth may have decided to leave school during or in the months after the face-to-face the training, in expectation of the productive grant and/or earnings from business. As reflected in qualitative interviews, several factors may have contributed to this decision, including financial barriers to education, lack of vocational training facilities available locally, as well as low perceived returns to schooling and lack of job opportunities for educated youth in study communities. Overall the aforementioned schooling findings are not surprising, given the business development focus of the livelihoods training. In fact, more youth submitted a business plan than an educational plan, especially among dropouts. Don’t read (Just FYI for Q&A): Started a new business: .181 pp impact Business in operation: 0.159 pp Purchased livestock: 0.122 pp Self-esteem: 0.90 on scale 1-5 Entrepreneurial attitude 0.20 on scale 0-1 Reports CES-D>-10: -0.065 pp (0.172 pp ATT) Dropped out secondary: 0.059 Current attendance (all): -.0.036 Females attending secondary: -0.070 Dropped out secondary: 0.071 28 T (15 received training) females v. 17 C females dropped out (Between R2 and R3: 12 v. 8)
- Caveats for interpretation: PSSN payment delays after March 2019 Wide net of outcomes; significant programme impacts on all outcomes not expected Timing of intervention components There was an observed decrease in secondary school attendance. This result is driven by dropout from secondary school in the subsample of females. Compared to males, females were more likely to be in secondary school at baseline, before the start of the intervention. Females also had a higher participation rate in the Cash Plus training programme. These factors may have contributed to the observed effects for female. Most dropouts happened prior to receipt of the productive grant. This suggests that payment of the grant did not lead to dropout, but that it was possible youth may have decided to leave school during or in the months after the face-to-face the training, in expectation of the productive grant and/or earnings from business. As reflected in qualitative interviews, several factors may have contributed to this decision, including financial barriers to education, lack of vocational training facilities available locally, as well as low perceived returns to schooling and lack of job opportunities for educated youth in study communities. Overall the aforementioned schooling findings are not surprising, given the business development focus of the livelihoods training. In fact, more youth submitted a business plan than an educational plan, especially among dropouts. Don’t read (Just FYI for Q&A): Started a new business: .181 pp impact Business in operation: 0.159 pp Purchased livestock: 0.122 pp Self-esteem: 0.90 on scale 1-5 Entrepreneurial attitude 0.20 on scale 0-1 Reports CES-D>-10: -0.065 pp (0.172 pp ATT) Dropped out secondary: 0.059 Current attendance (all): -.0.036 Females attending secondary: -0.070 Dropped out secondary: 0.071 28 T (15 received training) females v. 17 C females dropped out (Between R2 and R3: 12 v. 8)
- Women and girls are disproportionately vulnerable to poverty, particularly in women-led households, Hence: Have high HIV prevalence x2 higher Early sexual debut Violence victims Low prioritization of the need for girls’ education completion: Poor access to resources and decision making Unemployed /mostly informal sector/ less skills Women and girls’ lack of information and decision-making power: condom negotiation Poor access to SRH , GBV services
- Women and girls are disproportionately vulnerable to poverty, particularly in women-led households, Hence: Have high HIV prevalence x2 higher Early sexual debut Violence victims Low prioritization of the need for girls’ education completion: Poor access to resources and decision making Unemployed /mostly informal sector/ less skills Women and girls’ lack of information and decision-making power: condom negotiation Poor access to SRH , GBV services