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Cash Plus

Cash Plus

Evidence shows that direct payments of cash, or cash transfers, help the world’s poorest families meet their basic needs and generate a wide range of benefits, such as increased household productive capacity, improved children’s school attendance and better adolescent mental health. Despite this, cash transfers alone are not a ‘silver bullet’ for all aspects of poverty and wellbeing.

Research by the UNICEF Office of Research Innocenti, along with national and international research partners, governments and UNICEF country offices, shows that integrating cash transfers with other components, like health insurance, livelihood training, or links to sexual and reproductive health services, can generate additional benefits for individuals as well as their households. This combination of cash transfers and complementary programmes is called integrated social protection or cash plus.

UNICEF Innocenti is conducting research on a wide range of cash plus programmes in multiple countries. We combine impact evaluations with process evaluations, to better understand the role and quality of implementation of the specific programme components and design features. Most of the considered cash plus programmes combine cash with interventions for improving access to social services:

  • Fee waivers for national health insurance in Ghana.
  • Health insurance combined with linkages to social services and behavioural change communication in Ethiopia.
  • Water and sanitation combined with nutrition-related services in Burkina Faso.
  • Case management for protection and violence combined with nutrition behavioural change communication for mothers of children aged zero to two years in Mozambique.
  • Interventions that target adolescents in Tanzania through livelihood and sexual and reproductive health training, mentoring, productive grants, and linkages to health services.

Publications

A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Round 4 Impact Evaluation Report
Publication

A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Round 4 Impact Evaluation Report

This mixed-methods impact evaluation examines the impacts of “Ujana Salama” (‘Safe Youth’ in Swahili) which is a cash plus programme targeting adolescents in households receiving cash transfers under the United Republic of Tanzania’s Productive Social Safety Net (PSSN) programme. Implemented by the Tanzania Social Action Fund (TASAF), with technical assistance of the Tanzania Commission for AIDS (TACAIDS) and UNICEF Tanzania, the ‘plus’ component includes in-person training, mentoring, and grants. The impact evaluation examines the differential impact of the integrated programme (cash plus intervention targeting adolescents) when compared to the PSSN alone. This report describes findings from the fourth round of data collection (2021), conducted 18–20 months after the end of programme implementation as part of the broader Gender-Responsive Age-Sensitive Social Protection (GRASSP) research programme (2018–2024), led by UNICEF Innocenti and funded by the United Kingdom of Great Britain and Northern Ireland’s Foreign, Commonwealth and Development Office (FCDO). The impact evaluation found that most of the post-programme impacts were gendered. This includes sustained increases in economic activities by female youth, sustained increases in healthcare seeking by male youth and reductions in experience of sexual violence among female youth. Implementation of “plus” aspects such as training and mentoring was gender sensitive. However, conservative gender norms were influential as they negatively influenced programme impacts on contraception.
Ujana Salama: Cash Plus Model on Youth Well-Being and Safe, Healthy Transitions – Round 3 Findings
Publication

Ujana Salama: Cash Plus Model on Youth Well-Being and Safe, Healthy Transitions – Round 3 Findings

“Ujana Salama” (‘Safe Youth’ in Swahili) is a cash plus programme targeting adolescents in households receiving the United Republic of Tanzania’s Productive Social Safety Net (PSSN). Implemented by the Tanzania Social Action Fund (TASAF), with technical assistance of the Tanzania Commission for AIDS (TACAIDS) and UNICEF Tanzania, the ‘plus’ component includes in-person training, mentoring, grants and health services. The impact evaluation studies the differential impact of the integrated programme (cash plus intervention targeting adolescents) with respect to the PSSN only. It is a mixed methods study, including baseline (2017), Round 2 (2018), Round 3 (2019) and Round 4 (2021) surveys. This brief summarizes findings from the Round 3 survey, which was conducted one year after the training, three months after the mentorship period, and one to two months after grant disbursement.
A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood Round 3 Report
Publication

A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood Round 3 Report

“Ujana Salama” (‘Safe Youth’ in Swahili) is a cash plus programme targeting adolescents in households receiving the United Republic of Tanzania’s Productive Social Safety Net (PSSN). Implemented by the Tanzania Social Action Fund (TASAF), with technical assistance of the Tanzania Commission for AIDS (TACAIDS) and UNICEF Tanzania, the ‘plus’ component includes in-person training, mentoring, grants and health services. The impact evaluation studies the differential impact of the integrated programme (cash plus intervention targeting adolescents) with respect to the PSSN only. It is a mixed methods study, including baseline (2017), Round 2 (2018), Round 3 (2019) and Round 4 (2021) surveys. This report provides findings from the Round 3 survey, which was conducted one year after the training, three months after the mentorship period, and one to two months after grant disbursement. The previous report (Round 2) is available here.
Ujana Salama: Cash Plus Model on Youth Well-Being and Safe, Healthy Transitions – Midline Findings
Publication

Ujana Salama: Cash Plus Model on Youth Well-Being and Safe, Healthy Transitions – Midline Findings

This brief provides midline findings from the impact evaluation of a cash plus model targeting youth in households receiving the United Republic of Tanzania’s Productive Social Safety Net (PSSN). Implemented by the Tanzania Social Action Fund (TASAF), with technical assistance of the Tanzania Commission for AIDS (TACAIDS) and UNICEF Tanzania, the programme aims to improve livelihood opportunities and facilitate a safe transition to adulthood. The 'plus' component included training on livelihoods and sexual and reproductive health (SRH)-HIV, mentoring and productive grants, as well as linkages to youth-friendly health services. The impact evaluation is a longitudinal, mixed methods study. The midline analysis was conducted immediately after training (before mentoring, disbursement of productive grants and health facility strengthening).
A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Midline Report
Publication

A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Midline Report

This report provides midline findings from the impact evaluation of a cash plus model targeting youth in households receiving the United Republic of Tanzania’s Productive Social Safety Net (PSSN). Implemented by the Tanzania Social Action Fund (TASAF), with technical assistance of the Tanzania Commission for AIDS (TACAIDS) and UNICEF Tanzania, the programme aims to improve livelihood opportunities and facilitate a safe transition to adulthood.
‘Cash Plus’: Linking Cash Transfers to Services and Sectors
Publication

‘Cash Plus’: Linking Cash Transfers to Services and Sectors

Cash transfers have been successful in reducing food insecurity, increasing consumption, building resiliency against economic shocks, improving productivity and increasing school enrolment. Despite the many successes of cash transfer programmes, they can also fall short of achieving longer-term and second-order impacts related to nutrition, learning and health outcomes. A recent study highlights how so-called ‘Cash Plus’ programmes, which offer additional components or linkages to existing services on top of regular cash payments, may help address such shortcomings.
A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Baseline Report
Publication

A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood: Baseline Report

This report presents the evaluation design and baseline findings from a 24-month, mixed methods study to provide evidence on the potential for an additional plus component targeted to youth that is layered on top of the Government of Tanzania’s Productive Social Safety Net to improve future economic opportunities for youth and facilitate their safe transitions to adulthood. This pilot study is based on the recognition that cash alone is rarely sufficient to mitigate all risks and vulnerabilities youth face or to overcome structural barriers to education, delayed marriage and pregnancy, and other safe transitions. The model the intervention follows was informed by a workshop held in Tanzania in February 2016 with government, researchers and development partners.
How to Make ‘Cash Plus’ Work: Linking Cash Transfers to Services and Sectors
Publication

How to Make ‘Cash Plus’ Work: Linking Cash Transfers to Services and Sectors

The broad-ranging benefits of cash transfers are now widely recognized. However, the evidence base highlights that they often fall short in achieving longer-term and second-order impacts related to nutrition, learning outcomes and morbidity. In recognition of these limitations, several ‘cash plus’ initiatives have been introduced, whereby cash transfers are combined with one or more types of complementary support. This paper aims to identify key factors for successful implementation of these increasingly popular ‘cash plus’ programmes, based on (i) a review of the emerging evidence base of ‘cash plus’ interventions and (ii) an examination of three case studies, namely, Chile Solidario in Chile, IN-SCT in Ethiopia and LEAP in Ghana. The analysis was guided by a conceptual framework proposing a menu of ‘cash plus’ components. The assessment of three case studies indicated that effective implementation of ‘cash plus’ components has indeed contributed to greater impacts of the respective programmes. Such initiatives have thereby addressed some of the non-financial and structural barriers that poor people face and have reinforced the positive effects of cash transfer programmes. In design of such programmes, further attention should be paid to the constraints faced by the most vulnerable and how such constraints can be overcome. We conclude with recommendations regarding the provision of complementary support and cross-sectoral linkages based on lessons learned from the case studies. More research is still needed on the impact of the many variations of ‘cash plus’ programming, including evidence on the comparative roles of individual ‘plus’ components, as well as the knowledge, attitudes and behaviour pathways which influence these impacts.
Ghana LEAP 1000 Impact Evaluation: Overview of Study Design
Publication

Ghana LEAP 1000 Impact Evaluation: Overview of Study Design

This brief documents the impact evaluation design of the Ghana Livelihood Empowerment against Poverty (LEAP) 1000 programme which is being piloted in ten districts in two regions and targets about 6,000 households initially.
Utilizing Qualitative Methods in the Ghana LEAP 1000 Impact Evaluation
Publication

Utilizing Qualitative Methods in the Ghana LEAP 1000 Impact Evaluation

This methodological brief focuses on the qualitative component of the evaluation of the Ghana Livelihood Empowerment against Poverty (LEAP) 1000. Quantitative measures will indicate if LEAP 1000 reduces child poverty, stunting and other measures of well-being, while qualitative research explores in more depth the reasons why and how this may or may not be happening.

Journal Articles

A “Plus” Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth
Journal Article

A “Plus” Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth

Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities’ strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply-side barriers and social norms, or through additional linkages to economic opportunities.

Project countries

Project team

Valeria Groppo

UNICEF Innocenti

Essa Chanie Mussa

UNICEF Innocenti

Frank Otchere

UNICEF Innocenti

Nyasha Tirivayi

UNICEF Innocenti

Francesca Viola

UNICEF Innocenti

Partners

Videos

Related

Innocenti Project(s) 2016-2021:

Child labour

Child labour and education in India and Bangladesh

Child labour and social protection in Africa

Social protection and cash transfers

PROJECTS ARCHIVE

Infographics

Tanzania Theory of Change

Conference and meetings

Transfer Project Workshop 2019

International Conference on Universal Child Grants

Blogs

Mind the gender norm gap: How can a gender norms lens help advance better outcomes for adolescents through social protection?

Commentaries

Social Protection and Adolescence: Evidence, Promise, and Gaps. Policy in Focus on Children and social protection: understanding and responding to children’s needs

Podcasts

Tia Palermo on Cash Transfers, Gender and Impact of Research

'Cash Plus' for adolescents in Tanzania: How it started, where it's going, and why research matter

Journal articles

Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

Enhanced Life Distress Inventory: development and validation in two African countries

Impacts of a social protection program paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme

Child malnutrition, consumption growth, maternal care and price shocks: new evidence from Northern Ghana

Child marriage and associated outcomes in Northern Ghana: a cross-sectional study

Reports

Ghana LEAP 1000 Programme: Endline Evaluation Report

Ghana LEAP 1000 Programme: Baseline Evaluation Report

Power Point presentation

Child Marriage and Ethiopia's Productive Safety Net Programme

Government Anti-Poverty Programming and Intimate Partner Violence in Ghana

How are Social Protection Programmes Targeting or Inclusive of Adolescence?

Cash Transfers, Violence & Youth

Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

A Cash Plus Model for Safe Transitions to Adulthood: Impacts on the Sexual and Reproductive Health Knowledge of Tanzania’s Youth

Videos

Effects of Cash Transfers on Protection and Well-Being Outcomes for Women and Children

What's new

Impacts of the Ghana Livelihood Empowerment Against Poverty 1000 programme

The cash plus model: improving adolescent wellbeing with evidence

When cash alone is not enough: the transformative power of cash plus programmes

‘Cash plus’ interventions have potential for greater impact than cash alone

Briefs

Cash Plus: An Adolescent Livelihood, Health and Well-being Intervention as part of Tanzania’s Productive Social Safety Net Programme

Mradi wa Afya na Ujasiriamali Kwa Vijana: Hatua za Utekelezaji katika Kuboresha Maisha, Afya na Ustawi wa Vijana kama sehemu ya Mpango Endelevu wa Kunusuru Kaya Maskini

Ujana Salama Cash Plus Model on Youth Well-being and Safe, Healthy Transitions: Baseline findings