External Evaluation of the Bomi Social Cash Transfer Pilot Final Report … · 2019-06-07 · i External Evaluation of the Bomi Social Cash Transfer Pilot Final Report Dr. Candace

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External Evaluation of the

Bomi Social Cash Transfer Pilot Final Report

Dr. Candace Miller Zione Themba

Liberia Based Research Team

Francis Wreh Yusuff Sarnoh Joseph Kassellie Joseph Kwiwalazu

Boakai Sandimanie Anthony Dymacole Tuwuyor Belleh Gertrude Weah Moses Dayen Numamene Bakolay Famatta Innis Kerper Kei Ezekiel Nyenpan Albert Gebeh

Center for Global Health and Development (CGHD)

BostonUniversitySchool of Public Health Boston, Massachusetts

and

Liberia Institute of Statistics and Geo-Information Services (LISGIS)

Monrovia, Liberia

Understanding the Liberian CASH TRANSFER

June 2012

This report was prepared by the Center for Global Health and Development (CGHD) at Boston University for the Government of Liberia and UNICEF Liberia. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the funding agency or the Government of Liberia.

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STATEMENT OF GRATITUDE

To the people of Bomi County, we deeply appreciate the time you spent with us and the honesty with which you told your stories. To the entire research team, thank you for your incredible efforts, despite challenges and setbacks. This report is only possible because of your hard work and dedication to the people of Liberia.

“You know that poverty is a disease, when it strikes someone, everything that a person does is with poverty in mind. He does not even think about anything else.”

Male, Bomi County

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TABLE OF CONTENTS

STATEMENT OF GRATITUDE ......................................................................................................................................... I

TABLE OF CONTENTS ................................................................................................................................................... 1

MAPS .......................................................................................................................................................................... 4

EXECUTIVE SUMMARY ................................................................................................................................................ 6

THE BOMI SOCIAL CASH TRANSFER PILOT ................................................................................................................................ 6 EVALUATION OBJECTIVES AND INTENDED AUDIENCE .................................................................................................................. 6 METHODS ......................................................................................................................................................................... 7 RESULTS ............................................................................................................................................................................ 7 RECOMMENDATIONS ........................................................................................................................................................... 9

INTRODUCTION .........................................................................................................................................................13

BACKGROUND TO THE BOMI SOCIAL CASH TRANSFER PILOT PROGRAM ....................................................................................... 13 POVERTY, HEALTH AND HUMAN DEVELOPMENT IN LIBERIA ....................................................................................................... 13 CASH TRANSFER IMPACTS OUTSIDE OF LIBERIA ....................................................................................................................... 13 THE BOMI SOCIAL CASH TRANSFER PILOT .............................................................................................................................. 14 TARGETING APPROACH ...................................................................................................................................................... 14 CASH TRANSFERS (SIZE AND SCALING UP) ............................................................................................................................. 14

Table 1. Size of Cash Transfer ............................................................................................................................................... 15 OBJECTIVES OF THE IMPACT EVALUATION REPORT ................................................................................................................... 15

METHODS ..................................................................................................................................................................15

STUDY DESIGN ................................................................................................................................................................. 15 SAMPLE SELECTION ........................................................................................................................................................... 16

Figure 1. Intervention and comparison groups ..................................................................................................................... 17 SAMPLE SIZE .................................................................................................................................................................... 17

Table 2. Sample size estimation ............................................................................................................................................ 17 QUALITATIVE RESEARCH ..................................................................................................................................................... 18

In-depth Interviews (IDIs) ........................................................................................................................................ 18 Focus Group Discussions (FGDs) with Children........................................................................................................ 18 Focus Group Discussions with Community Members .............................................................................................. 18 Key Informant Interviews (KIIs) ............................................................................................................................... 19

DATA SOURCES AND TRAINING ............................................................................................................................................ 19 QUANTITATIVE ANALYSIS .................................................................................................................................................... 20 QUALITATIVE ANALYSIS: INTERVIEWS, FOCUS GROUPS ............................................................................................................. 20 RESPONSE RATE ................................................................................................................................................................ 20

Table 3. Quantitative Survey Sample Size ............................................................................................................................. 21

RESULTS .....................................................................................................................................................................21

DEMOGRAPHICS ............................................................................................................................................................... 21 Bomi County ............................................................................................................................................................ 21 Characteristics of Household Heads ........................................................................................................................ 22

Table 4. Demographics - Household Heads........................................................................................................................... 23 Household Composition .......................................................................................................................................... 23

Table 5. Household size ........................................................................................................................................................ 24 HEALTH AND HYGIENE ....................................................................................................................................................... 24

Table 6. Changes in Adult Health .......................................................................................................................................... 25 Table 7. Health status among all adults ................................................................................................................................ 25 Table 8. Household Expenditure on Health for households that reported health expenditures in previous year ............... 25

Children’s Health ..................................................................................................................................................... 25

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Table9. Health Status and Changes in Child Health .............................................................................................................. 26 Table10. Chronic Illnesses and Disabilities in Children.......................................................................................................... 26 Table 11. Healthcare according to Household Head ............................................................................................................. 27

Hygiene Practices .................................................................................................................................................... 27 Table 12. Hygiene Practices of Household Heads ................................................................................................................. 27

EDUCATION ..................................................................................................................................................................... 27 School Enrollment and Attendance ......................................................................................................................... 27

Table 13. School Enrolment for 6--18 year olds .................................................................................................................... 28 Table 14. Household Head Reports of Children’s Schooling ................................................................................................. 29

School Expenses ...................................................................................................................................................... 29 Table 15. Annual Household Expenditures on Education (in households that spent money on education) ........................ 29

Child Work ............................................................................................................................................................... 29 Table 16. Household Reports of Child Work ......................................................................................................................... 30

NUTRITION AND FOOD CONSUMPTION ................................................................................................................................. 30 Adequacy of Food .................................................................................................................................................... 30

Table 17. Adequacy of food consumption ............................................................................................................................ 30 Food Diversity .......................................................................................................................................................... 30

Table 18. Household Reported Eating Type of Food Product During One-week Period ....................................................... 31 Food Stores .............................................................................................................................................................. 31

Figure 3. Length of time food stores projected to last among all households reporting at least some stores. .................... 31 HOUSEHOLD ASSETS .......................................................................................................................................................... 32

Table 19. Household Assets, Farming Assets, and Livestock Ownership .............................................................................. 32 Table 20. Sleeping Conditions ............................................................................................................................................... 32

HOUSEHOLD EXPENDITURES ................................................................................................................................................ 33 Table 21. Household Expenditures (LD70=US $1) ................................................................................................................. 33 Table 22. Household Economic Situation .............................................................................................................................. 33 Table 23. Social Safety Nets .................................................................................................................................................. 34

USE OF CASH TRANSFER BY BENEFICIARY HOUSEHOLDS ............................................................................................................ 34 Table 24. Reported Use of the Cash Transfer by Beneficiary Households in the Last Month ............................................... 35

QUALITY OF HOUSING ....................................................................................................................................................... 35 Table 25. Quality of Housing ................................................................................................................................................. 36

DECISION MAKING AND BENEFICIARIES’ USE OF THE CASH TRANSFER .......................................................................................... 36 Table 26. Decisions About How Money is Used .................................................................................................................... 36

IMPACT OF CASH TRANSFER ON LIKELIHOOD OF EVENTS ........................................................................................................... 37 Table 27. Beneficiary Household Head Reported Likelihood of Events ................................................................................ 37

PSYCHOLOGICAL WELL BEING AMONG HOUSEHOLD HEADS ...................................................................................................... 38 Table 28. Psychosocial Well-being of Household .................................................................................................................. 38

QUALITATIVE ................................................................................................................................................................... 38 Table 29. Qualitative Activity, Sample Size, and Themes ...................................................................................................... 39

IMPACTS ON CHILDREN, ADULTS AND HOUSEHOLDS ................................................................................................................ 39 Variation in impacts ................................................................................................................................................ 42 Priorities for Using the Cash Transfer ...................................................................................................................... 43 Cash Transfer Businesses ........................................................................................................................................ 44 Community Perceptions of Impacts ........................................................................................................................ 44 Minimal Iimpacts and Undesirable Uses ................................................................................................................. 45 Community Level Impacts ....................................................................................................................................... 46 Local Economy ......................................................................................................................................................... 47

THE SITUATION OF NON-RECIPIENT HOUSEHOLDS ................................................................................................................... 48 Coping in Non-recipient Households ....................................................................................................................... 50

CHALLENGES FOR THE SOCIAL CASH TRANSFER PROGRAM ........................................................................................................ 51 TARGETING ...................................................................................................................................................................... 51

Concerns and Problems with the Targeting ............................................................................................................ 53 EMOTIONAL BLOW OF NOT BEING CHOSEN ........................................................................................................................... 55 JEALOUSY ........................................................................................................................................................................ 56

CONCLUSION .............................................................................................................................................................57

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STRENGTHS AND WEAKNESSES ............................................................................................................................................ 57 SUMMARY OF FINDINGS ..................................................................................................................................................... 58

Impacts .................................................................................................................................................................... 59 Targeting ................................................................................................................................................................. 61

RECOMMENDATIONS ......................................................................................................................................................... 62

WORKS CITED ............................................................................................................................................................65

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MAPS

Liberia in West Africa Bomi County in Liberia

Bomi County

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ACRONYMS CSPC – Community Social Protection Committee FGD – Focus Group Discussion GDP – Gross Domestic Product HHH – Household Head IDI – In-depth Interview KII – Key Informant Interview ME – Monitoring and Evaluation PI – Principal Investigator RA – Research Assistant SCT – Social Cash Transfer SCTP – Social Cash Transfer Program SCTS – Social Cash Transfer Secretariat UNICEF – United Nations Children‘s Fund

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EXECUTIVE SUMMARY

The Bomi Social Cash Transfer Pilot

The Liberian Social Cash Transfer (SCT) Pilot is a Social Protection program of the Government of Liberia. UNICEF Liberia provides technical support and together with the European Union and the Government of Japan, provided financial support. The Social Cash Transfer Program (SCTP) was designed to alleviate poverty and improve livelihoods, reduce hunger and malnutrition, and improve school enrolment among the poorest households that are also labor constrained. The SCTP delivers regular and reliable cash transfers to extremely poor households that are also labor constrained. Households are extremely poor when they have minimal assets and income and are labor constrained when there is no person aged 19-64 able to work either because of age, disability status, or high dependency ratios. Cash transfer programs have yielded positive impacts in African countries where poverty is pervasive and infrastructure is weak. However, the SCTP in Liberia is one of the first programs in a post-conflict society in West Africa. Given the important contextual differences between Liberia and countries with functional cash programs, it is important to examine the Liberian SCTP in an external evaluation when moving from a pilot project to a Liberian program. Thus, the Government of Liberia and its development partners and other stakeholders required an external evaluation in order to examine the SCTP‘s impact on beneficiary households and communities, as well as the SCTP‘s targeting procedures. The Government of Liberia and UNICEF Liberia have joined the growing number of countries and organizations committed to evidence-based decision making and using systematic evaluation data to develop social protection policies and guide policy and programmatic improvements. Evaluation Objectives and Intended Audience The purpose of the external evaluation was to assess the situation of cash transfer beneficiary households compared to non-beneficiaries and to better understand the SCTP‘s targeting outcomes. This report has two main objectives. The first objective is to use qualitative and quantitative methods to examine the differences between cash transfer recipient households (intervention) and non-recipient households (comparison), in the areas of food security, education, health and health-seeking behavior, asset ownership, housing quality, household expenditures, and the well-being of household members. The second objective is to assess the SCTP‘s targeting process to better understand whether targeting procedures are transparent, fair, and implemented as envisioned, whether cash transfer recipients meet the eligibility criteria of being ultra poor and labor constrained and whether eligible households were omitted from the program. (An economic evaluation and a comparison of targeting strategies were beyond the scope of the evaluation plan.) This evaluation is intended to provide high quality evidence on the Bomi Social Cash Transfer Pilot Program to the Government of Liberia, UNICEF Liberia and other stakeholders throughout Liberia and beyond, who are interested in the impacts and targeting of a social protection program for the extremely poor and labor constrained in a post-conflict society. The outcomes of the evaluation will

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inform the ongoing development of the national social protection policy and strategy as well as help guide decision making around the scale up of the cash transfer project. Methods This is a quasi-experimental, mixed-method, cross sectional study. The study consisted of the following evaluation and research activities: 1a Quantitative Household Survey with modules on food security, poverty, child health, child

development, health and other issues (222 households in total) 1b In-depth Interviews with 27 intervention and 27 comparison household heads 1c Focus Group Discussions with children (20 groups in total, ages 10-17 years) 1d: Focus Group Discussions with community members (12 groups in total) 1e: Key Informant Interviews with informants from education (n=8), health (n=8), agriculture

(n=4), business owners (n=20), and religious leaders (n=4) (44 in total) This study does not yield impact estimates or quantify the expected change over time due to the cash transfer. The stage of implementation, data limitations, and budget constraints precluded a randomized control trial. Still, while not a longitudinal evaluation, we were able to examine how households change when they become cash transfer recipients compared to similar households that were not selected for the SCTP. We present differences between households and attempt to determine whether differences can be attributed to the cash transfer. Additionally, the study design combined quantitative and qualitative activities in order to yield data on differences between an intervention and control group, insights into complex phenomena, obtain a wide range of perspectives, and confirm and verify findings. We included respondents of all ages, economic levels, and occupations in the qualitative evaluation activities. The range of respondents allowed us to gather data on different experiences across households and at different levels, such as among children, adults, households, communities and in local economies. Results Bomi County is among the poorest counties in Liberia and among the worst affected by the war, as various factions fought in Bomi in an attempt to take over Monrovia. Infrastructure is inadequate such that there are insufficient schools, health centers, and skilled health professionals. There are poor water and sanitation systems, roads and bridges, and limited access to technology. The war left many women widowed and children orphaned. In this context, we found important differences between the intervention and comparison groups in the quantitative survey.

CASH TRANSFERS: (Statistically Significant Differences) Health Health Improvements Adults: 56% of intervention vs. 29% of comparison respondents reported that health improved in the last year. Health Improvements Children: Caregivers reported that 74% of children in intervention vs. 37% of children in comparison households had improved health over the past year. Healthcare Adults: 57% of intervention vs. 27% of comparison respondents reported that they were more likely to seek health care in the last year. Healthcare Children: Caregivers reported seeking care for 97% of children in intervention households and 77% of children in comparison households for the child‘s most recent illness.

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Positive outcomes: In qualitative interviews and focus group discussions, the positive outcomes in intervention households were consistently attributed to the cash transfers. Intervention and comparison household heads, children, key informants and community members all described positive impacts within recipient households. For example, intervention household heads reported better health-seeking behaviors and health statuses among adults and children than comparison household heads. The health impacts were confirmed by the healthcare workers and other key informants, who reported observing important improvements among cash recipients. Intervention respondents reported significantly higher rates of school enrolment than comparison respondents, as well as reduced absences and positive changes in performance. Further, according to respondents there was a significant reduction in child work among children in intervention versus comparison households in the previous year (70% of children in intervention households and 52% of children in comparison households were less likely to work in the previous year). Intervention households reported better food security than comparison households. They were more likely than comparison households to report consuming at least two meals per day and feeling satisfied after meals. The intervention group also had food stores for longer than the comparison group. Household expenditures for food and non-food items were statistically different and higher in intervention versus comparison households. The intervention group reported important housing improvements, including reduced leaks and better quality roofing, walls and floors. Intervention households were significantly more likely than comparison households to share money with people outside their households (19% vs. 8%). They were also significantly more likely to start businesses than comparison households in the previous year (38% vs. 13%). Differential impacts: Despite the positive study findings, there were important differences within the intervention group, such that households receiving small transfers experienced much fewer impacts. Intervention adults and children from intervention households expressed frustration with small transfers (i.e. such as LD700 or LD1000), particularly when they felt that they did not receive enough money to send all children in the household to school. Key informants confirmed that some households were not able to send all children to school and that this was a serious issue. In these situations, there may

CASH TRANSFERS: (Statistically Significant Differences) Schooling Respondents reported that 92% of intervention children aged 6-17 versus 85% of comparison children were enrolled in school. Further, school enrollment was 94% for intervention girls and 89% for boys versus comparison households where 85% of girls and 85% of boys were enrolled. Intervention children had fewer absentees per month than comparison children (0.60 days versus 1.07 days). Again, girls in intervention households had the fewest absentees. Household heads reported annual school expenditures of LD1,831 in intervention vs. LD1,342 in comparison households (US26 vs. US$19 per year). Food Security and Assets 90% of intervention respondents and 26% of comparison respondents reported that household food intake had improved over the past year. An estimated 60% of the intervention group consumed two meals or more per day versus 28% of comparison households. Intervention households were more likely than comparison households to own a mattress, a radio, a house, and livestock such as chickens and ducks. An estimated 93% of the cash transfer was spent locally within Bomi County in the previous month.

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be three explanations: First, the base transfer may be insufficient to sustain the family. Second, the education bonus was not recalculated after children were enrolled in school, so parents who enrolled children subsequent to becoming recipients may not receive the bonus. Third, the program has difficulty capturing household composition changes, in part by design (to keep families from shifting children around in order to qualify) and because of infrequent retargeting. Undesirable uses: In the qualitative interviews and discussions, respondents provided several anecdotes of recipients using transfers for socially undesirable expenses. The frequency with which this occurs appears low, but complaints and reports of misuse emerged in the data in all study clans and should be considered a threat to the program if not addressed. Community level impacts and impacts on the local economy: We estimate that approximately 93% of the cash transfer is spent locally within Bomi County. We also found evidence of a myriad of ways in which the cash transfer generates positive impacts. Business owners reported that they were coming to rely on the cash households as important to their monthly sales and estimated that the transfer led to growth of between 20% to 50%. Some recipients shared money outside the household (19% of intervention versus 8% of control households). We also heard reports that recipients helped out non-recipient families when they had serious healthcare needs. Recipients also created employment opportunities with the transfer and made goods easier to obtain when they started local businesses in their communities. The situation of the control group: The interviews with comparison households and key informants and discussions with children and community members revealed that many non-beneficiary households in Bomi are extremely poor and destitute such that families go hungry and eat poor quality foods, lack adequate housing, and are unable to send children to school. Targeting: The targeting procedures must continue to be reviewed and revised in order to reduce fraud, errors, and corruption. (Fraud occurs when recipients misrepresent their situation in order to receive the transfer. Errors are mistakes made by the SCTP either in targeting, accounting, or other aspects of program management. Corruption is the deliberate cheating by implementers for their own gain or to influence the program.) We heard reports that SCT enumerators demanded bribes, coached households to respond to questions in order to boost chances of selection; and that on occasion, households were not selected or removed from the SCTP for arbitrary reasons (i.e. hair not grey). Furthermore, despite the revised targeting approach, implemented in 2011, that relied on SCT enumerators rather than community members, some eligible households were left out of the initial listing. (The approach has subsequently been revised from utilizing ad-hoc SCT enumerators to full-time, regularly paid, government employed SCT enumerators. This revised approach should be monitored and examined to determine its effectiveness.) Finally, there were also situations in which grievances were not heard or rectified. Recommendations The study findings provide ample evidence that—for the majority of cash transfer recipients—the impacts are transformative. Previously destitute households are able to make significant improvements in their lives and improve health, food security, children‘s education, asset ownership, and housing. These impacts spill over into communities and local economies. Still, we documented important potential threats to the program, such as misuse of the transfer, variation in impacts and problems with the targeting procedures. We offer recommendations for programmatic

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improvements so that the program yields the intended impacts as it expands to and throughout additional counties. Recommendations are to improve 1) operations 2) targeting procedures and 3) impacts. (According to UNICEF, some of the recommended revisions are already being developed.) To improve SCTP Operations, we suggest the following:

x Develop and implement a full monitoring system designed with checks and balances to regularly monitor all program activities. The system must have feedback loops for information to stimulate continued programmatic improvements. Regular but unannounced monitoring of SCT enumerators can reduce instances of bribery. Community outreach activities should be implemented to identify households that may have been overlooked during the targeting activities. Monthly SCT reports should be submitted and scrutinized to understand field challenges so that feasible solutions can be devised and implemented.

x Use multiple communication media to publicize aspects of the program, including the targeting procedures, eligibility criteria, payment levels, and expected uses of the cash. Empower community members to observe the process and report fraud or targeting errors. Spot check and monitor SCT staff that list households to reduce errors and corruption. There is an increased opportunity for fraud and corruption when communities do not fully understand the targeting criteria and program. While there is a risk that SCT enumerators or monitors could coach households or that households may commit fraud in order to obtain the cash, this could be reduced through better monitoring. Although the costs of improved monitoring have not been estimated in this report, the current approach, when further scaled throughout the country, risks serious inclusion and exclusion errors that would threaten the program‘s long-term sustainability.

x While attaching conditions to cash transfer programs has generally not been welcomed in many African countries because of low capacity to monitor conditions and inadequate infrastructure to deliver services, some countries (e.g. Kenya and Uganda and others) are empirically testing and comparing the costs and burden of conditions within cash transfer programs. It may be worth considering some conditions in Liberia to reduce the use of transfers on socially undesirable expenses.

x Establish and publicize grievance procedures so that there is a process for citizens to report perceived problems with the program. Problems should be documented and responded to appropriately. Grievance systems are not difficult to design, however, they do require staffing to ensure that problems and grievances can be submitted and that there is a process to respond to them.

To improve the program‘s targeting procedures and outcomes, we suggest the following:

x Add additional checks and balances to the current targeting process in order to reduce the ability of SCT enumerators or monitors to require and accept bribes. The SCT Secretariat could arrange spot checks and visit households to ensure that eligible households are chosen and to ensure that excluded households do not meet the program‘s eligibility criteria.

x Ensure that there is adequate staff in place at all levels in order to ensure quality and fairness as the program expands. The SCT Secretariat and staff must allocate more time to monitoring activities, ensuring that the right households are chosen, and that grievances are documented and rectified. To their credit, the SCT Secretariat office manages a wide range of activities. However, the work burden may be too great to manage the range of challenges that are inevitable in a country where the majority of people are poor, and where civil servants are not well paid and are often paid late. By ensuring adequate staffing levels, the

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SCT office can allocate more time to monitoring activities, ensuring that the right households are chosen, and responding to grievances.

x Develop additional community outreach methods to ensure that households are not overlooked and thus excluded from the transfer, particularly in hard to reach locations. We frequently heard of households that were not included because they were not listed or were not home when the SCT enumerators did their listing. If households are overlooked, they should be able to still be included in the program as long as they meet the criteria. We suggest using radio and other methods to build awareness of the targeting procedures as well as encouraging local leaders to be more aware of households that might meet the criteria but are difficult to find or visit. Transparency within communities has helped reduce targeting errors in other countries.

x We strongly encourage program implementers to examine whether the SCTP can be expanded to additional households within Bomi because we encountered a number of families that met the eligibility criteria but were excluded, despite their destitute circumstances. In some cases these families were not home when the SCT enumerators listed households. There were also corroborated cases where households were intentionally excluded despite meeting the eligibility criteria.

In order to maximize program impacts, we recommend the following actions:

x Provide business training skills to interested cash transfer households. Some recipients established businesses on their own and were successful while others encountered problems or took on strenuous businesses that were burdensome for children and adults. Partnering organizations could provide business training and assist with a market analysis to determine which businesses would be the most successful.

x Households should be sensitized to the problems associated with child labor, particularly in Liberia where children burn coal, mine and do other dangerous work in order to earn money for food and schooling. While child work in poor households without cash transfers may be inevitable in the absence of additional social protection programs, in cash transfer households, families should be sensitized to the dangers of child work. One condition of cash may be that children should not do harmful or dangerous work.

x Program implementers should consider launching a social norm campaign to build the culture of using transfers appropriately. Publicizing the positive uses of cash transfers can generate healthy competition, and inspire or shame recipients into using the transfer for food, health, improved housing and education.

x Program implementers should further link to health services, education and agricultural projects and other sectors to increase the likelihood of a range of positive impacts. While the SCT office is at capacity, there are community based organizations and non-governmental organizations that could provide additional services to cash recipients who are an active audience during monthly transfer disbursement gatherings at pay points.

x We suggest assessing how to further assist one person households that receive LD700 per month. For example, if the Secretariat or a partnering organization was able to link multiple one-person households together through a savings group (susu) these individuals might be able to pool money for greater impacts. Reassessing the transfer amount may also be necessary. The trade-off between fewer households with larger benefits versus more households with smaller benefits is a serious question for debate. This study does not have an adequate sample size or design for a full analysis of the transfer size versus impacts.

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Finally, given the widespread poverty in Bomi County and throughout Liberia and the number of households in a destitute situation, continuing to develop a responsive, reliable social protection system is essential to the human and economic development of Liberia. We found many households without labor that likely should have been included in the cash transfer. Based on the SCTP data, qualitative key informant interviews and focus group discussions, we conclude that these households were excluded because of targeting errors, rather than not fulfilling the eligibility criteria. We also encountered many extremely poor households with labor that require appropriate social protection solutions such as cash for work programs. As the cash transfer pilot program is scaled up throughout Liberia and the social protection system is further developed, we strongly recommend that stakeholders throughout Liberia continue to prioritize evaluation research to determine whether programs and policies are effective, to obtain impacts estimates, to reduce threats to program scale up and sustainability, to test and assess new and improved approaches, to determine what impacts cost, and to compare the costs of different approaches through a cost effectiveness analysis.

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INTRODUCTION

Background to the Bomi Social Cash Transfer Pilot Program The Liberian Social Cash Transfer (SCT) Pilot Program is a Social Protection program of the Government of Liberia. The SCTP was developed with technical support from UNICEF and financial contributions from UNICEF, the European Union, and the Government of Japan. The SCT was designed to alleviate poverty and improve livelihoods, reduce hunger and malnutrition, and improve school enrolment among the poorest households that are also labor constrained. The Social Cash Transfer Program delivers regular and reliable cash transfers to extremely poor households that are also labor constrained. Households are extremely poor when they have minimal assets and income and are labor constrained when there is no person aged 19-64 able to work either because of age, disability status, or high dependency ratios. The Liberian SCT pilot was implemented by the Government of Liberia, through the Ministry of Gender and Development. The design and the financing of the program were facilitated by UNICEF. In Bomi County, the Social Cash Transfer Secretariat is responsible for all operational aspects of targeting and delivering transfers to recipient households.i ,ii Before decisions are made to scale up the cash transfer program, the Government of Liberia, UNICEF and other stakeholders required an external evaluation in order to examine the SCTP‘s impact on beneficiary households and communities and to examine the program‘s targeting procedures. The Government of Liberia and UNICEF have joined the growing number of countries and organizations committed to evidence-based decision making and using rigorous evidence to guide policy and programmatic improvements. Poverty, Health and Human Development in Liberia Poverty is pervasive in Liberia due to more than a decade of war and a history of poor governance. In 2010, per capita GDP was estimated at US$247, which ranks Liberia among the poorest countries in the world.iii In 2007, the poverty headcount, or the ratio at the national poverty line, was 63.8%.iv Poverty is greatest in rural areas and particularly in Liberia‘s remote counties. As of 2008, 79% of urban and 51% of the rural population had access to improved water sources and 25% of urban and 4% of the rural population had access to improved sanitation facilities.v In 2011, life expectancy at birth was 58 years.vi The maternal mortality rate was 990 per 100,000 births (2008)vii and the infant mortality rate was 88 per 1000 live births (2011).viii The adult literacy rate was 58% in 2005.ix Education expenditures as a percentage of GDP were 2.8% in 2008,x which ranks Liberia at 144 among 163 countries in the world. The school-life expectancy rate was 11 years in 2000, when the latest data was available.xi In 2007, the percentage of children under five years old that were underweight was between 15 and 20.4%.xii Cash Transfer Impacts Outside of Liberia Cash transfer programs have yielded positive impacts in other African countries where poverty is pervasive and infrastructure is weak.xiii In fact, in a similarly designed program in Malawi, an external evaluation revealed impacts in poverty reductionxiv, food security and diversityxv, child educationxvi, reductions in child povertyxvii, improved ability for persons with chronic illnesses to access healthcare, and to provide for family members.xviii However, the SCTP in Liberia is one of

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the first SCT pilot programs in a post-conflict society in West Africa. Given the important contextual differences between Liberia and countries with functional programs that are yielding positive impactsxix, xx, it is important to examine the Liberian SCT in an external evaluation. The Bomi Social Cash Transfer Pilot Bomi was selected as the pilot county for the cash transfer program because of its exceptionally high level of food insecurity, which approached 75% in the 2007 Comprehensive Food Security and Nutrition Survey. The county‘s proximity to Monrovia also allowed better oversight and monitoring from the capital over the course of the pilot. The SCT program was launched in February 2010 and scaled up throughout Bomi County by September 2011 to reach 1,900 families (7,123 people), approximately 10% of the households in Bomi County. Targeting Approach Households are selected in a multi-stage process, led by enumerators or monitors from the Social Cash Transfer Secretariat (SCTS). The enumerators conduct two rounds of interviews in communities to determine whether households meet the eligibility criteria. Once households are identified by enumerators or monitors, town chiefs and the county social protection committees review the list, make corrections or approve households. The targeting approach was revised in 2010 and 2011 in order to reduce inclusion and exclusion errors. Prior to revisions, the targeting was completed by community volunteers. However, the original procedures led to serious inclusion and exclusion errors. Thus, the approach was modified to be less dependent on community processes given that solidarity and volunteerism is weak in Bomi County.xxi Households must meet the eligibility criteria to receive cash transfers. One criterion is extreme poverty which is determined by the household‘s food security, asset ownership, and whether there is any support for the household elsewhere. Second, households must be labor constrained, which is defined as having no adult between the ages of 19 and 64, or the adult is not able to work because of chronic illness, disability, or needing to care for more than three children, disabled or elderly people. Cash Transfers (Size and Scaling Up) Once households are approved as beneficiaries, they receive monthly transfers, which are paid at a local meeting point, where staff from a commercial bank and SCT officials manage the process (Photo 1). The value of the transfer depends upon the size of the household (Table 1). The basic grant is unconditional, though additional sums are added for children enrolled in school.

Photo 1. Paying the cash transfer

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Table 1. Size of Cash Transfer

Number of household members L$ per month US$ per month

1 700 $10 2 1050 $15 3 1400 $20 4 1750 $25

Additional amount for each child in primary school 150 $2 Additional amount for each child in secondary school 300 $4 Average payment size 1750 $25

According to UNICEF, there is donor commitment to scale up the SCTP to 5,000 households in Bomi and Maryland Counties through 2013. In line with the original selection of Bomi County, the order of counties for future inclusion is based on the level of food insecurity in each county. If scaled up nationally, it is estimated that approximately 50,000 families would meet the current program criteria.xxii Objectives of the Impact Evaluation Report The purpose of the external evaluation was to assess the situation of cash transfer beneficiary households compared to non-beneficiaries and to better understand the SCTP‘s targeting outcomes. Thus this report has two main objectives. The first objective is to examine the differences between cash transfer recipient households (intervention) and non-recipient households (comparison) in the following areas:

x Nutrition and Food Consumption (food security, satisfaction with consumption levels, food diversity, consumption of complex proteins, food stores)

x Education (enrolment, attendance, perceptions of performance) x Health and Hygiene (perceptions of health status, recent illnesses, health-seeking behavior) x Child Labor x Asset Ownership (durable goods, productive assets, livestock) x Housing Quality x Household Expenditures and use of cash transfer (food, assets, health, education, and other

items) x Well-being of Household Members

The second objective is to assess the targeting process to better understand whether procedures are transparent, fair, and implemented as envisioned; whether cash transfer recipients meet the eligibility criteria of being ultra poor and labor constrained; and whether eligible households were omitted from the SCTP. METHODS

The Boston University Institutional Review Board and the University of Liberia Institutional Review Board approved the study protocols submitted for the quantitative and qualitative portions of the evaluation. Study Design

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This is a quasi-experimental, mixed-method, cross sectional study. The study consisted of the following evaluation and research activities: 1a Quantitative Household Survey with modules on food security, poverty, child health, child

development, health and other issues (222 households in total) 1b In-depth Interviews with 27 intervention and 27 comparison household heads 1c Focus Group Discussions with children (20 groups in total, ages 10-17 years) 1d Focus Group Discussions with community members (12 groups in total) 1e Key Informant Interviews with informants from education (n=8), health (n=8), agriculture

(n=4), business owners (n=20), and religious leaders (n=4) (44 in total) The sampling frame for the intervention group was a roster of cash transfer households that were included in the SCTP because they were identified as being extremely poor and labor constrained. The sampling frame for the comparison group was a roster of households that were listed but were not selected for the SCTP because they did not meet the criteria of being labor constrained. In theory, the comparison group was an approximate counterfactual of the intervention group. The group met the poverty criteria, but according to the SCT office, did not meet the labor constrained criteria. This study does not yield impact estimates because it is not a longitudinal randomized control trial. The stage of implementation and budget constraints precluded undertaking a randomized control trial. Rather than presenting impact estimates, we compare households that were approved to receive the cash transfer with households that do not receive the transfer. We aim to determine whether intervention households have similar or better indicators than the comparison group and to determine whether differences can be attributed to the cash transfer. While attribution is difficult in many evaluations, in this case, we know which households received cash, we can observe what they bought with cash, and we know there were no other interventions that could have caused economic changes in households. Thus, we can attribute changes in these households to the cash transfer with some confidence. The quantitative portion of the study was conducted in clans where the cash transfer program had been operational for at least one year, while the qualitative portion of the study was conducted in clans where the SCTP had been operational for 18 months to two years. Still, we asked respondents about their current perceptions of the program with the revised targeting approach. Sample Selection We used the targeting data from the Social Cash Transfer Secretariat office in Bomi and randomly selected cash transfer households to form the intervention group. These were Category D households that should have met the program‘s eligibility criteria when the targeting activities took place in 2010 (Figure 1). We also randomly selected households for the comparison group that met the extreme poverty criteria, but did not meet the criteria of being labor constrained when the community level targeting process took place in 2010. In other words, the comparison group was comprised of households (in Category C) that just missed the eligibility criteria because they had a dependency ratio of three or better, rather than worse than three when the targeting exercises occurred. This non-beneficiary group provides a comparison to help show the change in households based on the cash transfer. Note that the quantitative data collection only occurred in clans where the revised targeting

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approach was implemented so that we did not include households from clans that used the earlier more problematic approach. We can thus generalize findings from the quantitative study to other clans that utilize the newer, revised approach.

Figure 1. Intervention and comparison groups

A Not poor, not labor constrained

B Not poor, labor constrained

C Poor, not labor constrained

D Poor, labor constrained

Sample Size The quantitative evaluation study was powered to examine the differences between households based on receipt of cash transfers. We hypothesized that the cash transfer would yield a 15 percentage point difference in food security between cash recipients and non-recipients (e.g. the proportion of households that consume two or more meals per day over one year); increase the percentage of households that own 3 or more valuable assets by 30 percentage points; and increase the percentage change in expenditures for all consumption categories of spending (Table 2).

Table 2. Sample size estimation

Domain Outcome Expected outcome in comparison and intervention households (respectively)

Expected Change Over Time

Food security Percent consuming 2+ meals per day 70%, 85% +15 percentage points Assets Percent owning valuable assets 50%, 80% +30 percentage points Poverty Difference between expenditures for

consumption categories 20% difference in

expenditures We planned to measure differences between intervention and comparison households in the domains of nutrition and food security, asset ownership, expenditure patterns, schooling, child labor, health and health seeking behaviors, well-being, and coping behaviors. Using the Decision and Support System‘s online Power and Sample Size program, we calculated the necessary sample size for a study to determine differences in the above outcomes given the following parameters and assumptions: Alpha = .04, the conventional estimates for a Type I error for a two sided test and Power = .80, or the probability of correctly rejecting the null hypothesis of equal proportions in the population. We estimated a sample size of approximately 210 households (105 intervention and 105 comparison households in Bomi County). In order to reach our desired sample size for the quantitative portion of the study, we oversampled households because we knew that some households would not be available for the interview for a variety of reasons. The sampling rosters contained 136 randomly selected intervention and 136

Labor Constrained: No able bodied adult aged 19-64 or a Dependency Ratio worse than three (dependents may be children, elderly, chronically ill or disabled)

Intervention group from Category D. Comparison group from Category C should be among poorest & near meeting labor constrained criteria. criteria.

Poverty: 48% below the extreme poverty line

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comparison households proportional to the size of the clans. The field team systematically enrolled households to maintain a sample proportional to the size of the clan. Again, this is neither a longitudinal study nor a randomized control trial. While differences between groups may be statistically significant, we cannot determine whether the differences are solely due to the cash transfer or isolate the effect size. We do not have baseline data to determine whether there were statistically significant differences between the intervention and comparison groups prior to the cash transfer intervention. We did however use limited demographic and economic data collected by the SCT Secretariat on each group, which indicated that all households were extremely poor during the targeting activities. Qualitative Research In the qualitative phase of the impact assessment, we conducted 1) in-depth interviews with intervention and control household heads; 2) focus group discussions (FGDs) with children aged 10 to 18 years from intervention and comparison households; 3) focus group discussions with community members; and 4) key informant interviews with local civil servants and community leaders, including health workers, agricultural workers, teachers, religious leaders, and business owners.

In-depth Interviews (IDIs) The purpose of the qualitative in-depth interviews (IDIs) with intervention and comparison households was to generate more detailed data and information on sensitive topics related to the economic situation of the household, depending upon whether the household received the transfer. For the IDIs, we identified households through a simple random sampling of all households that had been listed by the cash transfer office.xxiii Households receiving the transfer were intervention households and households not selected as recipients were comparison households. We selected a representative sample and interviewed the household head.

Focus Group Discussions (FGDs) with Children The purpose of the FGDs with children (ages 10-18 years) was to generate more detailed data and information on the situation of children in both intervention and comparison households and their perceptions of other children and families. We asked the young respondents about the experiences of children depending upon whether their families received cash transfers. Again, we used the rosters from the SCT office to identify intervention and comparison households and we invited children from these households to participate in separate FGDs. We held the discussions at a safe and private local meeting area.

Focus Group Discussions with Community Members The purpose of the FGDs with community members was to learn about community perceptions of cash transfer impacts on recipient households and on the overall community. We examined both positive and negative perceptions and concerns about the cash transfer program; perceptions of recipient behaviors regarding livelihoods, health seeking behaviors, and use of the cash transfer; the community‘s perceptions of the fairness of targeting; the existence of jealousy among non-beneficiary households; and perceptions of possible economic multiplier effects. We conducted FGDs with community members from villages where the program had been operational for 18

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months to 2 years. We asked local community leaders to help us invite community members, who had not been a part of any related evaluation activities.

Key Informant Interviews (KIIs) The purpose of these interviews was to assess perceptions of the impact of cash transfers on households and the community from the perspective of a variety of stakeholders. All key informants, including health care workers, teachers and headmasters, religious leaders, business people, and agricultural workers were familiar with the cash transfer program. Again, we examined both positive and negative perceptions of the cash transfer program. We asked what respondents observed in regards to recipients‘ use of the transfer, health seeking behaviors, and livelihood activities; the community‘s perceptions of the fairness of targeting; the existence of jealousy among non-beneficiary households; and perceptions of possible economic multiplier effects. During field work, we identified key informants and conducted interviews with local leaders from healthcare facilities and schools, agricultural extension workers, religious leaders, and business owners. Data Sources and Training First, we developed a structured quantitative questionnaire in English to obtain data on household food security, expenditures, safety nets, asset ownership, and household members‘ health and activities, as well as child education. The survey was circulated for comments and feedback. In Bomi County, we trained the team of research assistants (RAs) over one week prior to each round of data collection in order for RAs to understand the objectives of the study, learn the instrument and the purpose of every question, revise the survey instruments to ensure they were appropriate to the local context, conduct mock interviews, and pilot the instrument. Following the pilot, we debriefed extensively and provided ongoing training to ensure high quality interviews. We developed semi-structured guides for in depth interviews (IDI), key informant interviews (KII) and focus group discussions (FGD) in order to understand the positive and negative impacts of the SCTP on beneficiary households and in communities. In addition to the training described for the quantitative portion of the study, we also conducted training in qualitative methods over one week and provided ongoing instruction as interviews and focus groups were completed. The RAs participated in mock and pilot interviews, KIIs, IDIs, and FGDs. These activities were followed by reflective discussions and training and instruments were revised as needed. RAs conducted IDIs and FGDs in pairs or individually, depending upon their level of experience. They took handwritten notes of all interviews and focus group discussions were taped using digital voice recorders. The transcripts contain all direct quotes from each respondent. Transcripts were reviewed and interviewers were asked for clarification or required to make call-backs if necessary. Training consisted of the following modules:

x Introduction to the study x Interview methods, including managing the interview and training respondents, probing,

being aware of non-plausible or contradictory data, dealing with difficult interviews and challenges, and problem solving

x Qualitative versus quantitative methods (classroom instruction and discussion, mock interviews, pilot interviews)

x Data management (including collection, entry, cleaning, security) x Roles and responsibilities of team members

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x Human Subjects Protection After pilot testing the quantitative questionnaire, we revised the instrument and administered it to intervention and comparison households. Surveys were checked on a daily basis by study supervisors for consistency, plausibility, and completeness. Next, surveys were entered into the Census and Survey Processing System (CSPRO) database. If missing data or illegible markings were found during data entry, surveys were returned to supervisors to rectify with research assistants. If necessary, RAs returned to the household to fill in missing data or clarify responses. Data from the CSPRO database was examined in batches to check for missing or outlying data. For qualitative data collection, research assistants followed a schedule of conducting two interviews or focus groups per day and transcribed or typed notes and recordings on the second day. Field supervisors observed RAs and reviewed all reports to ensure accuracy and consistency between transcripts. They also obtained clarifications as needed, checked interviewer performance, and identified emerging themes. Field supervisors conducted daily debriefing sessions as well. Quantitative Analysis

In Boston, quantitative household surveys were transferred from the CSPRO database into Statistical Analysis Software (SAS 9.1) for data cleaning, recoding, and analysis. We created a data analysis plan in order to utilize all relevant data and then systematically calculated univariate and bivariate statistics for all variables. Qualitative Analysis: Interviews, Focus Groups

In Boston, we read and reread transcripts from qualitative in-depth interviews, key informant interviews, focus group discussions, and reports compiled from observations. Next, we identified key impact areas to guide development of codes for categorizing data in order to conduct a content analysis, which is a thorough review to identify salient themes and patterns of ideas related to study topics. The categorization of codes allows a rich and in-depth focus on specific concepts. We coded community key informant transcripts and focus groups using NVIVO 8 software. In all transcripts, we identified deviations from common themes and explanations for atypical responses, as well as anecdotes that provided insight into the broader study questions. We assessed corroborating and divergent views between study participants until we categorized all relevant concepts. Response rate Study vehicles returned to households at least three times (and sometimes more often if the vehicle passed the house regularly) in order to conduct interviews. Table 3 displays the sample size, by household status as well as reasons for loss to follow up. The numbers in each category are too small to perform statistical analyses.

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Table 3. Quantitative Survey Sample Size

C I Systematic sample (oversampled by 21) 136 136 Sample size 103 119 Unable to interview 33 16

Reasons unable to interview Migrated out of study clan 5 3 Not available after at least 3 visits 13 6 Death 1 1 Could not be found / Community did not know household name 14 6

Key: C= Comparison/control household; I = Intervention household RESULTS

Demographics

Bomi County We conducted the evaluation study in Bomi County Liberia. In 2005, the UNHCR/NRC population count was 105,345, while village mapping estimated a population of 159,779. An estimated 60% of the population are local to Bomi, 34% are returnees to who left Bomi during the war and have now returned, 5% are internally displaced people and <1% are refugees.xxivApproximately 40% are Christian and 60% are Muslim. Prior to the war, Bomi was economically vibrant with rubber plantations and mining companies. However, during the war, fighting often spilled from Monrovia to Bomi, resulting in deaths, displacement, the closing of businesses, and extensive damage to infrastructure. In Bomi, we conducted the study in the clans of Deygbo, Gorblah, Kpatiah, Kpo, Mannah Manoah, Moifeh, Tehr, and Zerpah and we spoke with leaders from each of the clans. According to the local leaders, today, the majority of Liberians living in these clans base their livelihoods on growing cassava or rice, charcoal burning, palm wine tapping, and rubber tapping either on private farms or the Sime Darby Plantation. Several clan leaders report that there are more women than men in their clans because of the deaths of many men during the war. We cannot confirm this however. While there have been improvements in infrastructure throughout Bomi since the war, there is need for improved access to water and sanitation facilities, more schools and health centers, and better quality roads and cell coverage. For example, throughout the study clans, leaders reported that there are insufficient hand pumps and many towns have no hand pumps. One clan has 39 towns and only 15 functional hand pumps and another town has 1,735 households and only ten hand pumps. Liberians in towns without hand pumps drink from running streams during the rainy season and dig wells in swamps in the dry season. These clans also lack sanitary facilities such that there are no toilets in the majority of towns and few improved latrines. (For more information on Bomi County, see The Bomi County Development Agenda 2008-2012).

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In study clans, we also found a shortage of primary schools. Although some are constructed of cement and brick, others are made of mud with a grass thatch roof. There is a severe shortage of secondary schools so that youth must be sent out of the clan or county to attend school or drop out. One clan has 46 towns with about 1,400 households and only 9 schools. In another clan, leaders report that some children must walk five hours per day to attend school. Clan leaders reported that teachers are often not paid regularly, which results in their

absences and poor performance. Clans also lack health clinics. One study clan has only one clinic and frequently has drug shortages, while another clan has only one clinic to serve 7,000 people. Another clan has one clinic but no physician. Throughout the study sites, we found poor infrastructure. Nearly all roads are dirt with deep potholes and ravines, as well as flimsy bridges constructed with inadequate materials. One of the clans has several towns that are inaccessible by road and can only be reached by boat. Several clans do not have cell phone coverage.

Characteristics of Household Heads The demographic characteristics of the heads in intervention and comparison households were similar with regards to age, gender, and the household head‘s most important activity (Table 4). In both groups, more than half of households were headed by someone over 65 years and the average age was 60 years in comparison and 63 in intervention households. Of course, intervention households received the cash transfer, but comparison households do not.

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Table 4. Demographics - Household Heads

Total N=222

C n=103

I n=119

% % Age <= 24 years 1 1 25-64 years 49 42 65+ years 29 30 >=75 years 22 27 Mean age in years 60 63 Gender (Female) 61 63 Most important activity Employed in organization 2 0 Self employed 15 14 Work on commercial farm 2 2 Work on household plot 29 21 Housework 0 2 Child care and housework mixed 4 0 Looking for work 0 2 No activity 41 48 Too sick to do activity 6 8 Temporary work 1 2 School 1 2 Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 NOTE: The p-value is the test of statistical significance. It is the probability of obtaining the results as extreme as the one that was actually observed. We "reject the null hypothesis" that groups are similar when the p-value <0.05.

Household Composition We compared the composition of study households to determine whether comparison households are similar to intervention households and can serve as a counterfactual. According to the data from the Cash Transfer Secretariat (collected by SCT enumerators or monitors), all of the comparison households in the study rosters met the program‘s poverty criteria, that is they owned no valuable assets and consumed one meal per day. The intervention group was more likely than the comparison group to have an unfavorable dependency ratio (73% vs. 59%, p<.05) (Table 5). While the two groups are relatively similar, it does appear that the intervention group is more demographically vulnerable than the comparison group, having more households with unfavorable dependency ratios and with disabled or chronically ill members. We also assess the comparison group to determine whether these households met the eligibility criteria for the cash transfer, but were not included in the program, which would suggests problems with targeting or errors of exclusion. It appears as though many comparison households fit the labor constrained eligibility criteria for the SCTP because the dependency ratio was worse than 3 (59%) or there was a one-person household that was elderly, disabled or chronically ill. Of course, the household composition may have been different at the time of targeting and later when the evaluation data was collected. However, in most all cases, respondents reported that there had not

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been any changes in their household. This study was not designed to measure the extent of exclusion errors, nor can we fully confirm that households that did not meet the eligibility criteria during the data collection did not meet the criteria during the SCT targeting activities. Table 5. Household size C

n=103 I

n=119

Average HH size (min, max) 4.5 (1,12 ) 4.1(1,12) Percent of one-person households 16 28 * Average number of children in households with dependents 2.8 2.3 Average number of able bodied age 19-64 1.7 1.6 Percent of households with members disabled or too ill to work 16 27 * Average dependency ratio in households with dependents 2.8 3.3 Percent with unfavorable dependency ratio >3 59 73 * Average dependency ratio in households with an unfavorable dependency ratio >3 3.6 3.4 Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 Health and Hygiene We asked respondents a series of questions about their health and the health of household members. Below we compare responses based on intervention status (Table 6). The heads of cash transfer households were more likely to report that health had improved among adults in the last year compared to non-transfer households (56% vs. 29%, p<.001). Intervention respondents were also more likely than comparison respondents to seek healthcare when sick (57% vs. 27%, p<.001) in November 2011, compared to November 2010 before the SCTP was launched. There were no differences based on the gender of the household head in reported health status or seeking healthcare when sick. Adults in intervention households were more likely than adults in comparison households to report a sickness in the past month (67% vs. 51%, p<.001) (Table 7). It may be that these adults were slightly older and had worse health to begin with, although it is not entirely clear. Still, overall, the majority of intervention respondents reported that their health improved over the year and 12% of intervention and 13% of comparison respondents reported that health had worsened in the past year. In all households, 21% of adults in intervention households and 11% of adults in comparison households had a disability while approximately 30% in both groups had a chronic illness. Household expenditures on healthcare were slightly higher among the intervention group, but the difference was not significant (Table 8). There were no gender-based differences for any of these measures.

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Table 6. Changes in Adult Health

C

n=192 adults %

I n=196 adults

%

Health Status over the past year Improved Stayed the Same Worsened

29 59 13

56 32 12

***

Health Seeking Behavior More likely to get care when sick No change in getting care when sick Less likely to get care when sick

27 45 28

57 29 14

***

Of those more likely to get care when sick, reasons more/less likely to seek care More Likely

Able to buy medicine Now have money or cash transfer money Able to get transport to hospital

Less likely Lack money No one to provide support No transport Poor treatment a health facility Too old Other

n=52 68 0

30 n=54

53 11 17 13 5 5

n=67 50 34 14

n=27 25 0

16 21 19 19

*** ***

Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10

Table 7. Health status among all adults

C n=192 adults

I n=196 adults

Health status % % Sick in past month 51 67 *** Chronic illness 31 30

Disabled 11 21 ** Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10

Table 8. Household Expenditure on Health for households that reported health expenditures in previous year

C n=66

%

I n=90 %

Average annual health expenditures in Liberian Dollars 993 1197 Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10

Children’s Health An estimated 74% of intervention children had improved health over the past year compared to 37% of comparison children (p<.001) (Table 9). Further, for a child‘s most recent illness, respondents sought care for 97% of intervention children versus 77% of comparison children (p<.001). There were no differences in reports of health status or whether healthcare was sought based on the child‘s gender. However, when respondents were asked whether seeking healthcare was more or less likely

Final Report 26

over the past year, they reported that it was more likely for girls than boys (61% versus 56%, p=0.002) in intervention households.

Table9. Health Status and Changes in Child Health

C

n=278 children %

I n=286 children

%

Since, last year has health status Improved Stayed the Same Worsened

37 59 4

74 24 2

***

Sought care for last illness 77 97 ***

Since, last year, Health Seeking Behavior for child More likely to get care when sick No change in getting care when sick Less likely to get care when sick

30 47 24

59 31 10

***

Since, last year, reasons more likely to seek care Able to buy medicine Now have money or cash transfer Able to get transport to hospital

Since, last year, reasons less likely to seek care

Lack money No one to provide support No transport Poor treatment Healthier than last year

n=61 68 0

28

42 15 22 18 4

n=155 51 30 16

35 0

12 31 15

***

Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 There were no statistical differences between children living in intervention and comparison households with regards to the percentage that were reported to have chronic illness or disabilities (Table 10). Also, there were no differences in reports of chronic illness based on gender.

Table10. Chronic Illnesses and Disabilities in Children

C n=278 childr

en

I n=286

children

% % Health status Chronic illness (ill for >1

month in past year) 5 8

Disabled 1 1 Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10 Overall, according to household heads, 58% of intervention versus 40% of comparison households reported that they had just enough or more than enough healthcare, while 42% of intervention and 60% of comparison households had less than enough healthcare to meet their needs (p<.05) (Table 11). There were no differences based on the gender of the household head.

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Table 11. Healthcare according to Household Head

C n=103

%

I n=119

%

Healthcare household receives More than enough Just enough Less than enough

5

35 60

8

50 42

*


Hygiene Practices There were no statistical differences between study groups in reported hygiene behaviors and practices for adults (Table 12). However, the heads of comparison households were more likely to give children daily baths versus intervention household heads who gave children baths less frequently, while 3% said that children never bathed.

Table 12. Hygiene Practices of Household Heads

Household Heads C

n=103 %

I n=119

%

Frequency household head uses soap when bathing Daily 4-6 times per week 1-3 times per week Never

89 8 2 1

91 3 6 1

Frequency household head brushes teeth Daily 4-6 times per week 1-3 times per week Never

91 4 2 3

85 8 3 3

Frequency children bath Daily 4-6 times per week 1-3 times per week Never

96 3 1 0

83 10 4 3

*

Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 Education

School Enrollment and Attendance Respondents reported that 92% of intervention children of school going age versus 85% of comparison children were enrolled in school (p<.05) (Table 13). We do not have baseline data to determine the change in enrolment over time, but we do know that intervention children had higher enrolment rates at the time of the survey. Although gender was not a significant predictor of enrolment in logistic regression models, within intervention households, school enrollment was 94% for girls and 89% for boys versus comparison households where 85% of girls and 85% of boys were enrolled.

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Respondents reported that 44% of intervention and 63% of comparison children had missed at least one day of school over the past month (p<.01). Intervention children had fewer absentees per month than comparison children (0.60 days versus 1.07 days per month). However, among the pool of children who had been absent in the previous month, there were no differences in the number of days absent indicating that the differences in mean number of absentees is driven by the fact that children in comparison households are more likely than children in intervention households to miss at least one day of school. Gender was a significant predictor of the absenteeism such that girls had fewer absences than boys. Within intervention households, girls were absent 0.54 days and boys were absent 0.67 days compared to children in comparison households where girls were absent 0.91 days and boys were absent 1.25 days per month. For children in school, household heads reported that 66% of intervention children and 48% of comparison children had improved school performance over the past year (p<.01) and they indicated that 14% of intervention versus 6% of comparison children had excellent performance. Still the majority of children were rated as having excellent or good performance within both groups. There were statistically significant gender-based differences in reports of child performance such that among children within intervention households, respondents reported that 12% of girls had excellent performance compared to 16% of boys. Within comparison households, respondents reported that 7% of girls and 5% of boys had excellent performance.

Table 13. School Enrolment for 6--18 year olds

C n=104

I n=201

% %

Percent enrolled 85 92 * Mean number of days absent per month (all) 1.07 .60 ** Mean number of days of absences among

those with absences (n=72, n=40) 2.9 3

Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10

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Table 14. Household Head Reports of Children’s Schooling

C n=164

%

I n=184

%

Change in Absenteeism Absent fewer days per week Absent same number of days per week Absent more days per week Not absent in last year

41 11 7 37

37 3 4 56

**

School Performance Excellent Good Fair Poor

6 81 9 4

14 68 10 8

*

Change in School Performance Improved Same Worsened

48 51 1

66 31 3

**


School Expenses There was a statistically significant difference in household school expenditures such that intervention household heads reported that they spent LD1,831 per year on school expenses versus LD1,342 in comparison households (US$26 vs. US$19 per year, p<.05) (Table 15). School expenditure data was not collected on each individual child so it is impossible to examine gender differences in school expenditures.

Table 15. Annual Household Expenditures on Education (in households that spent money on education)

Round 1 C I Mean in LD 1342 1831 * Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10

Child Work According to the heads of households, a greater percentage of children in intervention households were less likely to work over the past year than children in comparison households (70% vs. 52%, p<.05) (Table 16). Approximately 13% of children in comparison households and 5% of children in intervention households were more likely to work over the past year. This quantitative finding is consistent with qualitative reports of child work. We did not collect detailed data on child work so cannot examine differences in work based on gender or whether work that children in intervention households performed was dangerous; however in the qualitative section children described the work that they do. It may be that the heavy work burden is significantly reduced by the cash transfer and that when children do work, it does not interfere with school. Still, at least one child from an intervention household described how his mother uses the transfer to buy the materials needed to make coal. The boy and his siblings help make the coal which is a laborious, intensive process, especially for a child.

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Table 16. Household Reports of Child Work

C

n=82 %

I n=81

%

More likely No change Less likely

13 34 52

5 25 70

*

Nutrition and Food Consumption

Adequacy of Food About 90% of respondents in the intervention group and 26% of comparison respondents reported that household food intake had improved over the past year (p<.001) (Table 17). Further, about 60% of the intervention group consumed two meals or more per day versus 28% of comparison housheolds (p<.01). The intervention group was also much more likely to report feeling satisfifed after meals versus the comparison group.

Table 17. Adequacy of food consumption

C n=103

I n=119

Since last year, has the food intake in the household? % % Improved 26 90 Worsened 74 9 *** How many meals did this household take yesterday? No meals 2 2 One meal 70 44 ** Two meals 26 50 Three meals 1 5 Four meals 1 0

In the past week, how do household members usually feel after a meal? Too full 0 13 *** Satisfied 47 69 Somewhat hungry 51 17 Very hungry 2 1 Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10

Food Diversity There were few differences in food diversity when we asked what household members had consumed over the past week and no difference in a combined food diversity score; however there were differences in the percentage of households that reported weekly consumption of dairy items and beverages (Table 18). The difference in beverages is driven by reported fruit juice and soft drink consumption. However, there were differences between households in the number of items consumped per food group in the past week. For example, intervention households consumed more types of vegetables, meat or fish items, dairy products and cereals and grains than comparison households.

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Table 18. Household Reported Eating Type of Food Product During One-week Period

Percent reporting that food group was consumed in past week

Average number of items in food group consumed per

week

C n=103

%

I n=119

%

C n=103

%

I n=119

%

Cereals/Grains 97 98 ~ 2.1 2.5 ~ Roots/Tubers 94 88 2.4 2.4 Pulses 78 84 1.7 1.9 Vegetables 100 97 4.7 5.3 ~ Meat/Fish 91 90 2.0 2.4 * Dairy 17 33 ** .4 .6 ** Fruit 81 81 1.8 1.6 Sugar 99 98 1.7 1.7 Vendors (selling cooked items) 65 70 2.3 2.2 Beverages 33 48 * 1.8 2.0 ~ Spices 100 99 .4 .6 Food Diversity Score in past week (max-8) 5.6 5.7 Average number of meals with meat in past week 2.3 3.5 *

Percent that has food stores 19 30 * Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10

Food Stores Thirty percent of intervention versus 19% of comparison households had food stores (p<.05) and intervention households had food stores for longer than comparison households (Figure 3.)

Figure 3. Length of time food stores projected to last among all households reporting at least some stores.

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Household Assets Comparison households were more likely to own a variety of items including pails and buckets and metallic pots (Table 19). More intervention than comparison households owned a mattress, radio, a house, and livestock such as chickens and ducks. Further, on average, intervention households owned more of each item except sickles. Items that intervention households were more likely to own include metallic plates, mats, and mattresses. Intervention respondents were more likely than comparison respondents to sleep on a mattress, either on a bed or the floor (Table 19).

Table 19. Household Assets, Farming Assets, and Livestock Ownership

Household items C N=103

I N=119

C I

Percentage that own Mean number owned Metallic plates 25 34 2.0 2.9 * Pounding mortar 57 58 1.3 1.4 ~ Pails, buckets 95 88 * 1.8 2.2 ** Metallic pots 79 66 * 2.2 2.3 Utensils 92 89 3.8 3.8 Mats 65 58 1.4 1.7 * Mattress 30 47 ** 1.0 1.2 ~

Bed 35 44 1.0 1.2 Radio 4 21 ** 1.1 1.2 Cell 6 2 ~ 1.0 1.0 House 59 73 * 1.2 1.5 Farming Assets Hoes 50 53 1.3 1.6 Axes 33 37 1.1 1.3 Sickles 12 8 2.0 1.4

Cutlass 47 56 1.2 1.3 Animals Chickens 31 43 * 2.9 3.5 Goats 1 2 Duck 1 5 ~ Sheep 2 3


Table 20. Sleeping Conditions

C n=103

I n=119

Bed and mattress 13 21 * Bed and mat 17 13 Mattress on floor 13 29 Bed alone 3 4 Mat on floor 44 25 Sack or cloth on floor 2 3 Floor only or other 9 13


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Household Expenditures We examined household food consumption and food and non-food expenditures in detail by collecting data on consumption and expenditures for 112 food items and 47 non-food items (see the quantitative survey). For food consumption, we asked the household head whether members of the household consumed food items, and if so, whether the items were purchased, produced from their own plot, received as a gift or loan, or whether they found the item in the bush. Respondents were asked how much they paid for the item or the value of the item. There were significant differences in weekly food expenditures and per capita weekly food expenditures (Table 21). However, there was not a significant difference in the value of food that was consumed but not purchased. Consequently, the difference between study groups on total food expenditures was not significant. Next, we asked respondents about their weekly, monthly and annual non-food expenditures (Table 21). For each of these categories, the intervention group had significantly larger expenditures than the comparison group. Moreover, total consumption and expenditures was greater in the intervention group versus the comparison group, which is not surprising given that the intervention group receives the cash transfer.

Table 21. Household Expenditures (LD70=US $1)

C n=103

I n=119

Food expenditures LD US$ LD US$ Food Expenditures 823 $11.76 1222 $17.46 * Food Consumed but not purchased (n=101, n=111) 520 $7.43 433 $6.19 Total Food Expenditures 1320 $18.86 1641 $23.44 ~

Per Capita Food Expenditures 233 $3.33 400 $5.71 *** Per Capita Food Consumed but not purchased 138 $1.97 122 $1.74 Per Capita Total Food 364 $5.20 574 $8.20 **

Non Food Expenditures Weekly (only items that are typically bought on a weekly basis) 209 $2.99 277 $3.96 * Monthly (only items that are typically bought on a monthly basis) 383 $5.47 694 $9.91 * Annual (only items that are typically bought on an annual basis) 4038 $57.69 8288 $118.40 *** Total Non-Food Expenditures (all items made into weekly variable) 373 $5.33 594 $8.49 **

Total Expenditures Total Expenditures (made into weekly variable) 1693 $24.19 2647 $37.81 * Per Capita Total Expenditures 365 $5.21 801 $11.44 **

Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10 ^Food consumed but not purchased includes food that was produced by household, received as gift, received as payment, collected from bush or borrowed Approximately 65% of intervention and only 28% of the comparison group reported that the household‘s financial situation was better this year compared to last year, while 29% of the comparison and 13% of the intervention group reported that the household economic situation was worse this year compared to last year (p<.001) (Table 22). Table 22. Household Economic Situation

C I

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n=103 %

n=119 %

Economic situation since last year Better Same Worse

28 43 29

65 22 13

***

Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 The most commonly reported safety nets received by intervention and comparison households were school feeding programs, medical services and school materials (Table 23).There were no statistically significant differences in receipt of school feeding programs based on intervention status so that differences in food security were unlikely due to the school feeding program. The only difference between study groups was for medical services such that comparison respondents were more likely than the intervention group to receive medical services (47% versus 29%, p<.01), which further confirms that the intervention group was likely sicker than the comparison group. While the intervention respondents felt that their health had improved and were reportedly more likely to seek care if sick, they were more likely to be sick than comparison respondents.

Table 23. Social Safety Nets

C n=103

I n=119

Free food distribution 3 2 Food-for-work program or cash-for-work program e.g. Public Works Program 2 3 Inputs for work program 1 0 Free distribution of food to children and mothers 1 2 Supplementary feeding for malnourished children at a nutritional rehabilitation unit 3 2 Distribution of agricultural inputs (seed/fertilizer) 5 5 Food for displaced families / refugees 1 1 Food for returning household 1 0 Scholarships or bursaries for tertiary education (university scholarship\) 0 1 Inputs subsidy coupons 0 3

School feeding 46 50

Bursaries for Secondary education / high school 1 3 Money / loans 11 8 School materials 24 29

Medical services 47 29 **

Construction or building materials 1 0 Water / sanitation 23 19 Agricultural assistance (seeds, tools, training 3 3 Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10 Use of Cash Transfer by Beneficiary Households

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We asked the intervention household heads how they allocated the cash transfer in the previous month, how much they spent per category, and whether they purchased the item or service locally (Table 24). The most commonly reported expenditure categories were food, savings, and education. The highest expenditures reported were on food, education, and businesses. People used the transfer locally when purchasing school and education items, healthcare fees and transport, labor, agricultural inputs, and business activities. Fifty-nine percent of housing materials and 86% of household items were purchased within the study district. However, respondents went to Monrovia to purchase some items because they thought that prices were cheaper outside of Bomi County. We estimate that 93% of the cash transfer was spent locally within Bomi County in the previous month. We expect geographical variation such that households in more rural, less accessible areas likely spent a higher percentage locally, while households that live nearer to Monrovia may have spent a smaller percentage of the cash transfer locally. While respondents did not report using the cash transfer for alcohol, tobacco, or gambling, both key informants and participants in community focus groups reported that a small percentage of households did purchase these items. Children further corroborated these reports.

Table 24. Reported Use of the Cash Transfer by Beneficiary Households in the Last Month

Item (n=119) (%) of households that

reported spending cash

transfer on item in past month

If purchased, average spent in last month

in LD and US$

Of purchases made, percent who bought

locally, within village or County

Food 88 750 $10.72 95 Household items 18 277 $3.96 86 Clothing 26 364 $5.20 85 Savings 38 528 $7.54 100 School /education 35 694 $9.91 100 Healthcare: Medications 18 248 $3.54 85 Healthcare: Fees 18 260 $3.71 100 Healthcare: Transport 33 190 $2.71 100 Animals - - - Labor (paying workers) 3 200 $2.86 100 Agricultural inputs 3 550 $7.86 100 Business (Income generating activity 8 558 $7.97 100 Transport (not for Health Care) 13 232 $3.31 87 Housing 15 418 $5.97 59 Entertainment (video shows) - - - Alcohol and tobacco - - - Lending money to others - - - Gambling - - - Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 Quality of Housing While 76% of intervention respondents reported that the housing accommodations were more than or just enough, only 17% of comparison respondents reported that their accommodations were

Final Report 36

enough (p<.001) (Table 25). Fifty percent of intervention and only 12% of comparison respondents reported that housing had improved in the last year (p.001).

Table 25. Quality of Housing

C n=103

%

I n=119

%

Housing Accommodation/Structures Less than enough Just enough More than enough

83 16 1

34 61 15

***

Changes in housing over the past year Improved Same Worsened

12 45 43

50 29 21

***

Among those who made housing Improvements Built new home New door, window or other house fixture Roof (new/improvement Added a new structure Improved walls

n=11 9 9

64 0 9

n=58 12 30 50 9 0

Among those whose house deteriorated Bug or rodent infestation House fell down Roof damage (rain, wind, etc) Wall damage

n=43 2

29 63 12

n=22 9

27 45 18

Problems with housing House leaks House provides no protection from bugs and animals House protects against animals only House protects against bugs only House protects against bugs and animals

81 45 37 2

16

40 40 45 2

13

**

Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10 Decision Making and Beneficiaries’ use of the Cash Transfer The study groups were not different with regards to how financial decisions were made (Table 26). In about half of all intervention and comparison households, the household head alone made decisions about how to use money. In more than half of households, respondents reported that women made the financial decisions for the household, which may not be surprising given that the majority of households are female headed.

Table 26. Decisions About How Money is Used

C

n=103 %

I n=119

%

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Decisions about how money in the household is spent is made by: Household head only Household head only (no spouse in household) Spouse only Decisions made together (whole HH) Head and spouse only Others outside the household

51 26 5

12 5 2

49 29 5

11 4 2

Gender of person who makes household monetary decisions Male Female Both Male and Female together

30 53 17

26 59 15

Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 Impact of Cash Transfer on Likelihood of Events We asked respondents whether certain events or activities were more likely in the past year compared to previous years and compared results based on intervention or comparison status. Intervention respondents were more likely than comparison respondents to report that this year, compared to last year, children missed fewer days of school, were enrolled in school, sought healthcare for adults and children, and improved food quality and housing (Table 27). Intervention households were more likely than comparison households to share money or food with neighbors. This is consistent with findings from other countries, such as Malawi, where recipients shared a portion of their resources with other poor families.xxv Intervention households were also more likely to start a business compared to non-recipients (32% versus 12%, p<.001). In the qualitative interviews respondents reported businesses including selling eggs, candy and other petty items, making charcoal, and making and selling food.

Table 27. Beneficiary Household Head Reported Likelihood of Events

Type of Event/ Activities that respondents reported were more likely in the past year

C n=103 %

I n=119 %

Children missing fewer days of school 49 65 ~ Children being enrolled in school 51 71 * Seeking healthcare when an adult is sick 28 51 ** Seeking healthcare when a child is sick 46 72 ** Eating higher quality foods 7 45 *** Attending parties ( 0 13 *** Improving housing condition 20 50 *** Tilling fields 8 14 Planning for future 37 45 ~ Saving for future needs 24 42 ** Arguments or fights in household over money 0 5 *

Sharing money outside the household 8 19 * Sharing food outside the household 36 48 ~ Started a business 12 32 ***

Key: C= Comparison/control household; I = Intervention household; *** p<.001, ** p<.01, * p<.05, ~ p<0.10 Intervention households reported that arguments over money were more likely this year compared to last year, but the percentage reporting arguments was low at 5%. Furthermore, intervention respondents were more likely to attend parties, compared to non-recipient households. Cash transfer

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recipients often report improved social inclusion as they are able to improve hygiene, purchase clothing and contribute items to social events. While the survey asks whether respondents attend parties, it is not clear whether respondents contribute financially to these events. Psychological Well Being among Household Heads Intervention respondents also reported that their psychological wellbeing had improved over the past year (Table 28). Sixty-four percent of intervention versus 33% of comparison respondents reported that they were satisfied or very satisfied with life. There were no differences in the number of friends that household heads reported or whether households were accepted by the community.

Table 28. Psychosocial Well-being of Household

C

n=103 %

I N=119

%

HH head hopeful household situation will improve No A little Yes Do not know

12 15 60 14

8

14 75 3

*

HH head Satisfaction level with their life very unsatisfied unsatisfied neither unsatisfied or satisfied satisfied or very satisfied

12 55 14 19

3 19 13 64

***

Household head has close friends outside of the house 72 71 Average number of close friends the household head has 2.2 2.1 Household head would have some to go to borrow food if there was a sudden shock 38 33 Household is accepted in the community

No Yes Unsure

6

94 0

9

90 1

Household members experience discrimination because of poverty or other reasons 3 2 Key: C= Comparison/control household; I = Intervention household; ***p<.001, **p<.01, *p<.05, ~ p<0.10 Qualitative The quantitative survey enabled us to compare the intervention and control groups in detail across a variety of indicators. The qualitative interviews allow us to gain insight into the phenomena that emerges from the quantitative data, as well as examine themes and experiences where the quantitative survey was unable to yield detailed information. For each activity, we explored a range of themes for the report (Table 29). Although these were cross sectional interviews and discussions with respondents at one point in time, we were able to include a large number of respondents in these activities in order to obtain varying view points and verify findings.

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Table 29. Qualitative Activity, Sample Size, and Themes

In depth Interviews Focus Group Discussions Key Informant Interviews

Intervention Households n=27

Comparison Households n=27

Children from Intervention Households n=10 groups

Children from Comparison Households n=10 groups

Community members n=12 groups

Health workers (n=8), Educators, (n=8) Agricultural workers (n=4), Religious leaders (n=4)

Business owners n=20

x Impacts x Starting

Businesses x Spending

Priorities x Targeting x Corruption x Linkages

x Situation in these households

x Coping mechanisms

x Perceptions of impacts among recipients

x Perceptions of targeting

x Impacts, changes in life

x Starting Businesses

x Targeting x Problems

with SCTS

x Situation of children

x Perceptions of impacts

x Perceptions of targeting

x Impacts on households, community, local economy

x Variation in impacts x Misuse of transfer x Targeting

perceptions x Jealousy x Corruption

x Impacts x Capabilities x Jealousy x Targeting (Good, bad,

problems) x Corruption

x Know of transfer

x Business affected

x What do they buy

x Growth x Local

economy

Impacts on Children, Adults and Households First, during in depth interviews, intervention households described the positive impacts they experienced since becoming cash transfer recipients. The majority of respondents described their ability to purchase food and improve their housing, both of which improved their health and the health of household members. Respondents reported using the transfer to make important purchases, such as food and school materials, which allowed children to go to school. They also purchased household and productive assets.

―Things have changed. Before I never used to have money and we used to go and look for kiss meat (snails) before me and my family could eat. All of my children were not going to school. Things were very difficult for me, but now I am grateful for this program. This program has changed my life. It has helped me to send my children to school and I am now living in my own house… I have planted rubber for my children‘s future and I can now pay people to brush my cassava farm. I am now able to help myself. Before I started receiving this money, if you saw me… but now I am okay, always happy and I am satisfied with my condition.‖ (Female, Age 38, Household size=6, Intervention Household) ―I used to wash people‘s clothes before I could eat. I used to scratch fields and fetch water for people before I could eat. Now the story has changed since I started receiving the cash transfer. I am now able to buy my own food and take care of my family.‖ (Male, Age 78, Household size=2, Intervention Household) ―Yes things have changed, because the way my family and I were looking. We are not like that anymore. When my husband died some years ago, things were very bad for us. To get food was not easy. It was hard for us… before I even talk about children going to school. But since I started getting this money, my whole story has changed. Look around you. I never had all these things here. From the money, I bought a chair. I plastered the floor. I bought a mattress for my four children and myself. When I never used to receive this money, only two of my children were in school. But since I started receiving it, all my children are in school. Not only that, they can eat before going to school. I can give them money for lunch. Before they come from school, food is ready, and there are lots of

Final Report 40

good things happening for my family from this same money.‖ (Female, Age 42, Intervention Household)

The majority of intervention children also described positive impacts such as eating better foods, going to school and living in improved housing. Intervention children were no longer expected to work for other households for food. Children still performed household chores and in some cases, they contributed to household businesses.

―We are all happy. We are always satisfied when we eat. And I think this is most important in life: when you have food to eat.‖ (Intervention child FGD) ―Like other children whose parents are getting the cash transfer, I am less likely to miss school. The only time I think will miss school is when I am sick, which is very rare… I will not miss school because of uniforms, shoes, book bag or school fees that are not paid on time.‖ (Intervention Child FGD)

There were several reports from children whose situation changed so that they were no longer required to perform difficult labor in order to earn money for the household.

―My father doesn‘t work because he is paralyzed and since he started receiving the cash transfer, he can buy some of the important things we need, especially food and our school materials… Before my father started receiving the cash we used to go at the gold creek to work for money… Well, thank God now things are much better because I don‘t have to go to the gold creek again to work for money to go to school.‖ (Intervention Child FGD)

―At first my mother was not having money. She used to go to help those that burn charcoal before she bought food for us to eat. But because of this money, we are going to school. We can eat on time and we can even wear some good clothes.‖ (Intervention Child FGD)

In one FGD, all reported cash transfer uses were positive:

“My parent buys uniforms and pays my schools.‖ ―My mother buys clothes and my uniforms for school. She prepares my food. When my mother takes the money she buys eggs for us to sell.‖ ―The effect of the money on me is very good. I am benefitting from it. When my grandfather gets the money, he pays my school fees of which I am grateful.‖ “My grandfather is helping me, feeding me, and I am benefiting from it.‖ “I am benefiting from this money. My father buys food for us when he gets the cash transfer.‖

Health workers confirmed positive impacts on health.

―As a voluntary health worker, I think their [recipients‘] health has improved. They don‘t get sick like they used to… Only the very old ones like the old man… are constantly sick… But their children and the younger ones are very healthy. They are all eating very well. In fact, after they get the money every month, just looking at what they buy in their shopping bags makes me amazed. They eat nutritious food.‖ (Health Worker)

Final Report 41

―Before then these people use to come around and beg. Even when you are administering drugs and you ask if them if they have eaten, they will always say that they have not eaten. You personally as a nurse will have to give them money or food to eat. But now things have changed, it is not like before anymore. People are not getting diarrhea like they use to suffer from it. So many sicknesses like malnutrition sicknesses are not seen like before. Also ulcer and pot belly sickness that come about from not eating on time is not regular at our clinic like before. I think the cash transfer is actually having an impact on the people and community. From where I sit as a health worker, I can with no doubt say that the impact on health is there and it is great.‖ (Health Worker)

One health worker described the mental health burden that poverty places upon people but noted that the cash transfer relieves the worry and stress that harms physical health.

―No one is getting sick because of the hope of this money also. When the mind is thinking much, there is always some kind of sickness that will come. To be always worried causes one to be emotional sick which may result into the physical malfunctioning of the body.‖ (Health Worker)

Another health worker explained the connection between adequate food and taking or adhering to medicine. Prior to the cash transfer, patients may not have taken medicines due to the toxicity of pharmaceuticals when the patient has not eaten.

―For the health aspect; the clinic is free... The only thing I see is that they are not coming like before because at least now they have something to eat. If they come to the clinic and take medication they will now take their medication. Unlike before when they would say that they do not have food to eat and hence ‗how can they take medicine?‘ Therefore they were coming back with the same problems like gastritis, diarrhea and malaria.‖ (Health Worker)

Most of the informants from the education sector agreed that the impact on child schooling was positive; however, some respondents did not see the impacts that they expected.

―The transfer is making a tremendous impact especially in the lives of students. These children used to be all around the place doing nothing because their parents were not able to send them to school. Now things are changing; they are in school and are happy about it.‖ (School Principal) ―Well children whose parents are receiving the cash transfer always get to school on time. They always have their uniforms. Their uniforms are usually clean… This is saving a lot of lives. I don‘t know where else these people would have gotten such a favor from if the social cash transfer program would not have come in. People that should have died from sicknesses are alive; people that should have died from hunger are alive; all because of cash transfer.‖ (Teacher) ―As a teacher, I have observed that there are even some children, whose household receive money, that are not even active or participating and are hungry in class. This really confuses me because they [the households] are receiving and I don‘t see it reflected in their children. ‖ (School Vice Principal) ―Like I said earlier, there are a lot of improvements in them. Talking about performance, being regular in class and their livelihood has changed and this is encouraging.‖ (Teacher) ―I will say yes, some of their children are going to school. They are performing well and they are really doing good. But there are still some of them that I know and their children are not going to school and they are not well taken care of because they are not using the money they are receiving in the right direction.‖ (Teacher)

Final Report 42

―Well I think it is because they are a bit relieved from their low level life… I may say that some of them did not know the importance of sending their children to school but by the grace of God, this year people changed and started sending most of their children to school. It is only those who are not serious that are stubborn and do not want to buy their children‘s school uniforms.‖ (School Administrator)

Religious leaders also confirmed that they observed many positive impacts and that the recipients had improved capabilities because of the transfer.

―It is helping to send children to school. It helps them to seek treatment when they are sick either by attending the hospital or buying medicines. It helps… for the people to build their own houses or change the roofs of their houses from thatch to zinc. It helps the people to eat food as well as rescue any members of the family who encounter any trouble. It is also helping people to start their own businesses. It helps them begin agriculture projects like making cassava farms, potato farms, rice farm etc.‖ (Imam)

Variation in impacts The impacts varied most obviously by the level of transfer. While recipients receiving larger transfers could easily meet basic needs and invest the remaining transfers in larger housing improvements or businesses, some recipients reported that the transfer only helped them survive. Several recipients reported minimal changes because the transfer size was not large enough:

―Yes life has changed a bit because I can now get food for them [children] to eat even though it is only one meal a day. For their school, I think I still need some help because even to buy their exercise books is not an easy thing. I have two children in school but they are not giving me money for their school as they do to others. There are some people who have children who are going to school and [they] are receiving money for their children‘s school. I still thank God for everything… My ability to take care of children has improved but not so much. I thank God for the money but it is not really enough for me and my two children... I thank God that I am the only one who usually gets sick and I can get my medication for blood pressure... The money [cash transfer] I get is LD750.‖ (Female, Age 73, Household size=3, Intervention Household)

For this woman with two children, it is not clear why she is only receiving LD750, as this is below the transfer size that a three-person household is allotted. It may be that the children were not with her when she was targeted. The program has difficulty capturing household composition changes, in part by design (to keep families from shifting children in order to qualify) and due to infrequent retargeting. Otherwise, it may be that someone is taking a portion of her transfer. She could be misrepresenting the amount she receives, however this is unlikely as we were clear that we would not report any information from the interview back to the SCT Secretariat. Further, the woman genuinely believed she was receiving the right amount.

―I think from the year since I started receiving the cash transfer (LD600), a little bit of change has begun. … We also want the other children to start going to school but the cash is not even enough… All I want is for the government to please see reason and come to my aid. I am a human being with life why should I be suffering like this? Don‘t I deserve those basic needs for living? I feel like I have been abandoned and left alone to die leaving my children [grandchildren] behind to suffer like me.‖ (Male, Age 70, Household size=8, Intervention Household)

Final Report 43

Again, it is not clear why this recipient is receiving LD600, rather than LD700. Either a SCT enumerator or family member maybe siphoning off a portion of the transfer.

―If someone is unable to work and very poor and is receiving LD700, can it do anything for that person? Do these people expect them to survive on LD700 for the entire month? …people should include more old and suffering people in our town and increase the amount of money.‖ (Community FGD)

Intervention children in FGDs also reported that the transfer size was too low:

―I want them to add the money up [increase the transfer] because the money is not enough for my mother… she can do many things with money like buying of food and sending us to school and clinic.‖ (Intervention child FGD) ―As for me I cannot say I miss less days [of school] because we are many in our household and so this money is not able to pay all of our school fees. And sometime I can be put out for schools fees. ‖ (Intervention child FGD)

Several children reported that they experienced minimal impacts because of their relationship to the household head. Children living with an aunt or uncle did not benefit the same way children living with a parent or grandparent would. Some children lost support when a family member died:

―Once your parents are receiving the cash, their children don‘t need to do hard work. But unfortunately for me, I am living with my aunt and am still forced to do hard work.‖ (Intervention child FGD) ―The money is not doing good now for me because my uncle and his wife parted. So when the money comes, my uncle can use it on his new wife, children and family.‖ (Intervention child FGD) ―…the cash transfer was helping us until my grandfather died. Before then the money was helping me in school. But my grandfather did not leave a person to sign for the money… Now that he is no more, we cannot receive it anymore.‖ (Intervention child FGD)

Each of the these above problems are examples of issues that should be addressed with a proper beneficiary monitoring system, which can provide data and evidence to inform programmatic improvements and can link households to social services.

Priorities for Using the Cash Transfer Intervention respondents described their priorities for the monthly transfer, which tended to be food, school supplies, housing, and business investments. For example:

―When I get the money the first thing I do is buy rice. After that, if some money is left I can buy small things like cubes, salt, dry pepper, red oil, etc for the house. For household items I buy zinc to change the roof … because the entire house was leaking. For the children that are in school, I buy their uniforms, school shoes, book bags, copy books etc. ….[Regarding housing] It was important because it was during the rainy season and at that time every part of the house was leaking. We had pans and buckets sitting in every part of the house making the entire house very wet. That is why it‘s was important that we change the roof. Secondly, the most important thing was that I bought was cement to plaster every pot hole in the house.‖ (Male, Age 79, Household size 5, Intervention Household)

Final Report 44

―Whenever we get money I first think about food for my children. After, I think about their school. I

think this a good decision.‖ (Female, Age 40, Household size=7, Intervention Household)

―The top priorities for how I spent my money are: 1) Food: my household needs food to live. When there is no food to eat, we will not be able to get house or health care and the children will not go to school. 2) Healthcare: when people in the house are not well, they will not be able to work, sell or to do anything; the children will not go to school or play with their friends. 3) School: When my children are educated, they will help me when I am old and take care of their own home.‖ (Female, 53, Household size=4, Intervention Household)

Cash Transfer Businesses Some households reported that they used the transfer to start businesses, which earned them additional income that was greater than the transfer alone.

―I usually buy goods to sell. Goods like chicken, eggs by the carton, bags of candy, bags of rice and other things… I usually get the money into my business first and then I use the profit from my business to feed my household… I use the same profit to send my children to school. I usually don‘t get any money directly and spend it. I always multiply my money before I spend anything from it. This is what I always do.‖ (Female, Age 37, Household size=7, Intervention Household) ―I invested the money into coal business, where I went in the bush, bought sticks, gas and paid the power saw man to cut into pieces, pack it, put dirt on it and put fire in it. My children and I monitor it until after one week. When the coal has burned up, my children and I bag it… After I sell the coal, I was able to put all of my children in school. To be frank, coal work is very hard, but it get lots of profit. So I decided to make it my own business. What I can do is this, when I get my first pay, I can use it to buy sticks. Then the second can be used to buy gas and to cut the sticks to pieces. Then my children and I can continue from there.‖ (Female, Age 42, Intervention Household) ―For me, I am benefiting because my mother can pay people to brush her cassava patch. It also has being able to start a petty business, which has been it tremendous help for us.‖ (Intervention child FGD) ―My parents have now started a small business which we can depend on to get some of these things we need. Things like food, clothes, school uniforms shoes and also our good health. I am getting these things now, I am better than those who are not benefitting from the program. Those people who are not receiving the cash transfer; their children usually go to tap rubber, cut contract on farms and burn coal to get money. (Intervention child FGD) ―And my mother can also buy cassava and… make fufu for me to sell around the town and also to factory camp. [We do this] to make more [money] to buy other things for the house like buckets, top clothes and the mattress that we are sleeping on now.‖ (Intervention Child FGD)

Community Perceptions of Impacts In focus group discussions with community members, participants described both positive and negative uses of the cash transfer, which of course, led to varying impacts. The positive uses were for food, schooling, housing improvements, savings clubs (i.e. susu), and for starting businesses.

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―Some of those that are getting the money are making good use of it. They are doing some business, selling and turning it around. They are also sending their children to school and taking good care of the children especially when they are sick. I see some of them doing this and I even know their houses.‖(Community FGD) ―In addition to what I said previously, when the people receive their money, they always use it for the intended purpose, in that they buy food, renovate their houses and send their children to school. They are really taking good care of their children, their health care and other things.‖ (Community FGD) ―Some of the people are using their money to build their houses. When we came from the war, there were many thatched houses in this town, but now this money is helping some of the people to build zinc houses or change the roofs of their houses.‖ (Community FGD)

According to an agricultural worker, there were improvements in farming and increased production:

―In my role as an agricultural worker, I have seen that the ability of some of the recipients to grow crops, store food for hungry days, do many good things. There are some of them that are involved into rice farms also.‖ (Agricultural worker)

FGD participants also described gender specific impacts and how women in particular are able to use the transfer to improve their family‘s lives:

―I can say that some of the women that are receiving this money, their husbands were killed during the war and their children did not have anybody to help them but since they started getting the money they are using the money very well, thus, sending children to school and providing food for them.‖ (Community FGD) ―Most of the women who are getting this money have no husbands because they were killed during the war and, prior to the cash transfer, they were very poor. But, because of the money they are getting, they are doing things now. One of the women gave me money so that I can help to build her house and I was so surprised.‖ (Community FGD) ―Some of the people that are receiving this money are in a club. Some of them are saving their money so that at the end of the year, they can get some money. This money is helping really.‖ (Community FGD) ―Some of them are sending their children to school. Some of them lost their husbands during the Liberia civil war. It is this money that is helping them to do business, send their children to school and provide food for them.‖ (Community FGD)

Minimal Iimpacts and Undesirable Uses Some community members observed minimal or no differences among recipients despite receiving the cash transfer. These respondents were frustrated because they perceived the transfer as an important opportunity to positively impact households and the community. These anecdotal reports came up consistently but were generally limited to several cash recipients per clan.

―As he rightly said, some of them are using the money wisely, but some of them are not using it in the right way. They are not using it for the purpose which they get it for. When some people receive

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this money they only buy food and drink. Their children are not even going to school. They are in the same old houses they were living in; no improvement at all.‖ (Community FGD) ―Some of the people are using it good way; but some of them are not using it wisely. To be frank, some of the people are not doing any good thing with their money. This money was giving for the people to improve their living standard but some of the people are using it good way.‖(Community FGD)

The reported undesirable uses of the cash transfer were on alcohol, gambling, tobacco and instances where women attracted boyfriends with the cash transfer and gave the money to the boyfriend, who used the cash for gambling. While they mention a small number of cash recipients, it is important to note that these reports came from key informants, other recipients, children and community members. These reports are likely credible as descriptions of misuse were not limited to households that were expecting to receive the transfer but excluded from the program.

―Some of the recipients are just buying clothes, food, and not even talking about sending their children to school. They are taking care of themselves and forgetting about the children.‖ (Community FGD)

: ―Yes, some people upon receipt of the cash transfer they go into a shop and offer their friends some drinks and drink excessively to the extent that others have to drag them home.‖(Community FGD) ―Yes, I know one lady who when she gets the money. She starts drinking on the spot. All her children are not going to school and when you ask her she says that the money is very little, her life is still the same, and her children do not even have slippers on their feet.‖ (Community FGD) ―The frustrating part is that some of the old and the young are using the money for drinking, smoking, womanizing and even gambling… One of them told me that ‗It is free cash and I will use it in any way I want‘ and another one said ‗We are not working for the government yet it is paying us.‘ (Community FGD) ―I know a lot of them who abandon their families. They will be with their families, but as soon as they receive the cash, they do not go back home until the cash is finished and they go back home empty handed.‖ (Community FGD) ―They should remove that those that are not using the cash wisely. They are involved in gambling, drinking, smoking and not taking care of their families; children neither.‖ (Intervention child FGD) ―My main problem is mainly with the young girls… If their boyfriends or husbands do not have money… they give the money to their men telling them to decide what they should do with the money. When they take pay, the whole night there can be a big problem or party in this town... Where I live, we do not sleep in peace at all. They (the men) disturb our sleep throughout the night on the gamble board.‖ (Community FGD)

Community Level Impacts In the focus group discussions, community members described a range of positive impacts at the community level, creating a community-wide safety net, increased social support, and pride in the community.

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―The people that are taking this money are doing well. Their children are neatly dressed to go to school every morning. This money is helping the people because myself, I had an accident at a certain point and it is the recipients who put their money together and brought it to me to get help.‖ (Community FGD) ―The impact that I have seen as a religious leader is that these people are not helpful only to the household alone but they are also helping the community members.‖ (Imam) ―The program has a lot of positive impacts on the community because whenever the people get the money and open businesses or building houses in the community it means the community is improving. Its making a lot of changes, it brings pride to the community.‖ (Community FGD)

Local Economy Respondents also described how cash transfer households impacted the local economy by creating employment, stimulating the economy, and opening businesses which made goods more accessible.

―Yes the community is benefitting from the cash transfer money because some of the people who are receiving the cash are using it to send their children to school and that alone is a great help to the community. Besides that, some are using the money to buy zinc to build new houses in the community. Some are using the money to open businesses in this community. Even those that had old houses are changing their roofs from thatches and replacing it with zinc.‖ (Community FGD) ―What I have observed about this money is that some people are paying laborers to brush their farms and they plant their cassava and make fufu out of it. They are able to send their children to school and some of them are using the money to build their houses.‖ (Community FGD) ―We can say that the cash transfer program is making some impact on our local economy because these people when they get paid they buy from the people who are doing some business and it is helping them to grow.‖ (Community FGD) ―It is good because it is helping us. When they go and get the money they buy goods which they sell in our town and we do not have to walk to far towns to buy our things. Local businesses are also being helped to make more profit because there is now money coming in this community. ‖ (Community FGD)

Local business owners described their perceptions of cash transfer impacts on their businesses and the local economy. Seventy-five percent of business owners thought that the cash transfer impacted their business. Among these, the majority described how the cash transfer led to their businesses‘ growth. Respondents described growth of 20% to 50% that could be attributed to the cash transfer.

―Most times they buy salt, notebooks, umbrella, knifes, hoe, and other materials for their house.‖ (Shop Trader) ―They normally buy biscuits, peanuts, milk and even rice which I sell by cup and this is regular, it happens on every pay day.‖ (Business Woman) ―My business has been affected in a good way, when the people get their money, they come to buy from me. So, it is helping my business to grow. I have more sales now. They have also encouraged me to sell some building materials like nails and hinges to use for building their houses and put their

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zinc on the roof. There are sales throughout the year … my focus is to build the business. So, when I sell, I use the money to buy other things because I want this business to grow bigger than this.‖ (Business Woman)

―Yes, my business has been affected by the cash transfer recipients…They can come to my business and buy other goods from me and as they buy, I will used the money to buy other goods.‖ (Business Woman)

―It is having a good impact on the local economy in that the money is spent on our local businesses. It is helping to grow our businesses. … At first there were not many people buying from me. At times it use to take one to two weeks before I could buy new goods for my shop… This year my goods can only last for few days and my business is growing by God‘s grace. On the cash paydays, my business can pick up from the cash transfer recipients. They usually come around the payday weeks to buy from me and other sellers around here.‖ (Shop Trader)

The Situation of Non-recipient Households In contrast to the positive change in the majority of cash transfer households, the in depth interviews with non-recipient comparison households revealed the difficult situation that these families live in. The majority of respondents report severe poverty, food deprivation, health and other problems. For example:

―My mother was born in this town. She got married here and born us here. She never got anything for us. She died poor in this village and I am her too. The same thing is happening to me. I don‘t have enough money to take care of my children and myself and I am already old. So, I think this is just the trend of my family or it is will of God for our family: to be poor. I don‘t know what is happening to us.‖ (Female, Age 50, Household size=5, Comparison Household) ―When I was young I use to make farm. My household economic situation has changed from better to worse over the year… because I am old now. Before, when I was younger, I used to work and make my own farm but now my age cannot permit me now to do hard work, so my income had changed from better to worse… My children… I had ten in number but all of them died. Three died in the war and the rest of them die from sicknesses.‖ (Female, Age 69, Household size=4, Comparison Household) ―The children attended school last year, but in this year there is no money to send them to school. The health condition of the children is also not good because of the lack of money. As I told you, there is no agricultural productivity this year. In this year, the overall wellbeing of this household is not good.‖ (Female, Age 85, Household size=6, Comparison Household)

―The hard time is increasing on me… My children are not attending [school] this year. My house is seriously leaking on us. As you can see, when it rains, the house leaks on us… I have nothing to do for my living but only depend on God… My children and I can go to weed grass from people‘s farm before we eat. (Female, Age 40, Household size=7, Comparison Household)

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Each of the above respondents met the eligibility criteria to receive the cash transfer based on their household circumstances, yet they were not selected to receive the cash transfer. Respondents also explained that they had no other source of support to provide assistance:

―I am doing nothing, I am 86 years old, what do you think I can do? So I really need help, No wife. No brothers. No sisters. Just me.‖ (Male, Age 86, Household size=1, Comparison Household) ―Life has not changed because things are hard. No one is around to help us… Another thing is that, because of the hard time, many Saturdays we don‘t have food to eat. For Sundays, most times neighbors feels sorry for us when they cook they extend their hands to us. My main concern is for my children. I allow them to eat the food while I remain empty. Most of the time, I go around to neighbors to eat and they give some of their food to eat… I really don‘t care if they are giving it to me willingly or not. My major thinking is to survive. I have to eat and so I don‘t look for attitude of giver when I am hungry.‖ (Female, Age 43, Household size=5, Comparison Household)

In FGDs with children living in comparison households, participants described bleak situations and compared themselves to children in intervention households. Overall, their primary concerns were for food and they wanted to be able to go to school. The majority of children from comparison households reported that at least one parent had died and many children reported that both parents had died. Some children still were emotionally suffering from the loss of parents during the war or injuries suffered during the war:

―My major concern is my foot because during the war a small bullet hit my leg and my leg was cut off my body. So my major concern is how I can move around with just one leg.‖ (FGD with children from comparison households) ―My major concern is that since my father died, I am not able to go to school. To even find food to eat is not easy and I need someone to help me to go to school.‖ (FGD with children from comparison households) ―My major concern is long time ago my father died and I don‘t have anybody to help my mother presently. I am not even going to school; the only way we I get something is if some relative that are living in Monrovia send anything for us, this is the only way.‖ (FGD with children from comparison households)

Children who were not in households receiving the cash transfer compared their circumstances with children whose families were recipients:

―For the people who are getting the money they are now eating good food while we are still eating cassava with red oil, so I can feel bad because we don‘t have food to eat. When my parents were

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living I never used to suffer like this. We don‘t even have dishes at our house.‖ (FGD with children from comparison households) ―We don‘t have mattress to sleep on while they have mattresses. They have pots and dishes while we don‘t have. Their children are going to school so they will learn good things. Children like us need the same opportunities to go to school and eat good food.‖ (FGD with children from comparison households) ―They are sending their children to school and we are not going to school so they have good opportunities. They are building houses and we don‘t have….‖ (FGD with children from comparison households)

Many children in comparison households described harsh working conditions:

―If my mother were to be benefitting, I could not be brushing cassava farm, burning charcoal, standing near the heat (charcoal burning oven) and cutting sticks. I do not see some of our friends doing hard work. The only work they do is to wash dishes and sweep.‖ (FGD with children from comparison households) ―If my mother were receiving this money I could not have been hurling charcoal on my head…We hurl the charcoal from the farm… It takes four hours… I can feel bad when I am working hard like that.‖ (FGD with children from comparison households) ―If my mother were receiving, I would not have been doing hard work like burning coal. The process of burning coal- cutting the sticks, hurling grass… is difficult. It can make me to get sick. I do this to go to school.‖ (FGD with children from comparison households)

Coping in Non-recipient Households Comparison households reported several coping mechanisms such as stinting and eating less food than desired, praying and hoping to be selected as cash recipients in the next round of targeting, begging, working for neighbors, and going without.

―Sometimes we can‘t eat for two to three days but I try my best to pay their school fees buy their uniforms, shoes and copy books… The school is very important because if my children go to school and learn by God‘s grace; they may become someone tomorrow and I will benefit from them. Even if it causes me to not eat for two or three days I will do it just to pay their school fees. When God bless them they start taking care of me. I will forget about all the hunger and suffering I went through. The second thing I spend on is food because I have to eat and live… if my children don‘t eat they will die. You know that food is very important but I can go hungry for my children to go to school.‖ (Female, Age 29, Household size=9, Comparison Household) ―Most of the time I help people to clean their cassava farms, to clean their yard or do their house work. Each day I help three to four people. Some give me cassava, some rice and some money. That is how we are surviving. If there is no one to help then that day we don‘t eat.‖ (Female, Household size=8, Comparison Household) ―There is no fertile land left for us, no greens, and no edible roots like cassava to eat. We only fix brooms and sell in Sass Town market every Wednesday and this market is far. My husband has also been sick for almost a year now.‖ (Community FGD)

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―I want for the world to know that my parents are dead. I am living with my grandmother. We are in the bush all day looking for cassava to make fufu. I want to go to school because my grandmother doesn‘t have money to buy my school necessities so I am not going to school.‖ (Comparison child FGD)

Challenges for the Social Cash Transfer Program Both cash recipients and their children described several operational problems with the cash transfer Program that they hoped could be improved. First, often the bills they receive are old and in poor shape and the distances they travel to some of the pay points are too far given health problems and the age of recipients.

―When they bring the money to us, most of the money is already torn and mutilated. They can‘t be used again… in Liberia, people hardly accept mutilated money... So such money is useless to me… (Male, Age 78, Household size=8, Intervention Household) ―They should stop bringing tear cash because business people refuse it and we don‘t have used for it any longer.‖ (FGD with children from intervention households) ―Let them stop giving my grandmother mutilated especially the five dollars note ‖ (FGD with children from intervention households) ―I want them to change the place our parents are taking the money because the place is too far from the town and our parents can walk some four to five hours just to get their money and sometimes they get credit from people to go for their money.‖ (FGD with children from intervention households)

In the last quote, the child is explaining how his parents must take a loan in order to pay for transport to pick up the cash transfer. Targeting Despite the improved targeting approach implemented in mid-2011, we identified several concerns such that not all eligible households were receiving the cash transfer (exclusion error) and some recipients may not have met the eligibility criteria (inclusion error). We asked comparison non-recipient respondents, key informants, and community members whether they believed the appropriate households were included in the program. Some respondents believed that yes, the targeting was done correctly, but there are more households that should be included.

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―Yes the right households were chosen because all the people that are getting this money in our town are people that were suffering…We are happy that they are receiving it but the only problem is that the poor people are many and only few people were chosen. Some of us have the same problem the people that were chosen had, but we were left out.‖ (Female, Age 65, Household size=5, Comparison Household) ―Yes, they chose people based on their conditions; they really deserved it. The lives of most of the people were terrible. Also there are others too that were really needy and deserved the cash transfer but were left out. My understanding about this is they were left out because the cash transfer team was targeting a certain amount of persons. So whether or not you deserve or qualified some people had to be chosen and some people had to be dropped.‖ (School Principal)

Again, while many eligible households were chosen, additional eligible poor households were excluded. Even though the targeting approach was revised, it appears as though errors of exclusion persist. Respondents described the situation of some of the poorest households were not selected:

―Who am I to tell if the right household were chosen or not? That is their work and they know how they are doing it. Look at the way I am suffering. They took my name only to come back and tell me I am not chosen. I do not even have a mat to sleep on. Maybe the people who need it where the ones they gave it to… Some of those people that are getting the cash are strong and able to work… some are suffering, but not all of them.‖ (Male, Household size=1, Comparison Household) ―There is a blind woman whose name was taken during the listing and later they dropped her from the program and they told her that her name did not come out so she cannot receive the money and this woman is suffering. It is the people in the town who help her with everything.‖ (Community FGD) ―I am saying no because, there are some people who are poor and labor constraint and are not receiving the cash and they are suffering. For example, there is man who has nine children and his wife, and doesn‘t have the hand to send every one of them to school. There are many people in this district, who met the criteria but were left out… But they [SCT enumerators] did what they had to do… They [people in the district] are really suffering because, some of them do not have food to eat and cannot send their children to school and they do not have bed or mattress to sleep on and they are living under bamboo thatch card houses. Some are disabled and sick but are not receiving the cash. They [SCT enumerators] didn‘t even take their names at that time… They [people living in the district] don‘t have anyone to take of them, and all by themselves also unable to work. These people are in need and are very poor.‖ (Agricultural Worker) ―They are not the deserving household because there are two persons that I know of, who are recipients of the cash transfer, who are not poor and they are able to work. They [cash recipients] are able to work for themselves and get money but yet they are getting this money.‖ (Agricultural worker)

Similarly, of the non-recipient comparison households that we conducted in depth interviews with, fifteen respondents reported that they thought the targeting was implemented well in their village, while eleven believed there were problems and that the worst off, eligible households were not selected. The remaining two respondents were unsure. Additionally, respondents described inclusion errors whereby ineligible households were included.

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―I will say yes and no… In some instances I can say yes the right people got the money. This is so because you see how poor they were before. On the contrary too, you can some other people that did not deserve the cash transfer. They were not really poor. They have big farms and businesses and they are not really old... Yes, we feel very bad but cannot do anything about it. We pray that one day our names will be included on the list.‖ (Female, Age 50, Household size=5, Comparison Household) ―I think some of them deserve the transfer but some are not in that those that really deserved getting the money are not getting all because of self-interest. For example, there is woman who is poor and has no means of getting food to eat. But because we are not related, I will take her name from the list and put my relatives name whether or not the person is qualified. This is an example of some of the things that took place in the selection of people… This is what I am saying. There are many households in this community that met the criteria but were left out.‖ (Health Worker)

Concerns and Problems with the Targeting Several respondents recalled the targeting activities in their clan and described problems with the targeting procedures. It is difficult to ascertain the extent of errors, fraud or corruption within the process without investigating each report or without extensive notes and documentation from the SCT Secretariat. For example, there were reports of SCT enumerators requiring or accepting bribes in exchange for selecting the household. It is clear that beyond actual incidences of fraud, errors and corruption, insufficient communication may have elevated expectations and raised suspicion of an unfair selection processes. Still, there were enough reports of inconsistencies and bribes that these accusations should be taken seriously. In some cases, the SCT enumerators made seemingly arbitrary decisions. We also heard that households that appeared to meet the extremely poor and labor constrained criteria could have been removed from the program and were told that ‗the computer ate their names‘ or that the actual recipient was another person in the same community with the same name.

“For me, I don‘t know the people and don‘t know the mandate given them so I cannot say that those that are receiving are the right people or not. The only thing is that we are praying for cash money program that we were not privileged to be a part of... In fact, when I told them that my husband is dead, they compelled me to show his grave and I showed them his grave but when they came back, the only thing I heard was my name was not chosen.‖ (Female, Age 43, Household size=4, Comparison Household) ―I am feeling very bad because my name was taken and didn‘t come up. Can you imagine one name came up and they said it is not my own but another person? Some of us are very poor and unable to work yet we were left out and some of the people that are receiving the money are not suffering buy

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still they are getting the cash… You know those people that were taking our names down did their own thing they wanted to do.‖ (Female, Age 29, Household size=9, Comparison Household) ―These people always say that the computer ate people‘s name.‖ (Community FGD) ―I will feel bad because when they came they never reached my house and my name was left out so if my name is not taken again I will feel bad.‖ (Community FGD)

Several respondents complained of favoritism among the SCT enumerators and selected households:

―There was favoritism done in the process. Certain families were just favored. In fact in some places, they were taking money from people and if you didn‘t have money to give them, they could leave you out.‖ (Agricultural Worker) ―There was a lot of favoritism carried out in the selection of names for the cash transfer. The social cash workers knew certain people personally and these people were taught how to behave and answer the questions before they were being interviewed so they appear most needy and deserving… In this clan… some were left out because they were not literate or educated to certain things that they should have known and these people were played on by Cash Transfer Team. They did not meet the criteria because they were not literate to the questionnaire and so because of this they could not meet the criteria. These few groups of people that I am talking about did not know how to answer the questions. And most people, who knew how to answer the questions correctly but were not poor, disguised themselves: they took mattresses from their houses and other things out too just to meet the criteria. They were informed to disguise themselves so as to meet the criteria. So those who really needed it didn‘t know how to answer or present themselves; hence, they didn‘t meet the criteria.‖ (Vice Principal)

Respondents also mentioned special agreements between SCT enumerators and selected households. They described how SCT staff and community members were ‗gaming‘ the system.

―Just as I say, the people came here and start taking people‘s names. I asked them [is the] money … only for the person receiving or what. They said no, it is for the people and their children, so it can help send children to school. I asked them suppose you take this money and you have one child but you need to have two children or three children, then what do you do [to be on the Program?] The answer was, you can ask someone for his or her children so that when you take the money you and that person can share it.‖ (Shop Trader)

We heard various reports of older people that were denied because they refused to pay L$500.00 or any other amount to be on the list as well as reports of recipients that were not paid for extended periods. It is important to note that this story below is one of the only reports of violence that we heard about in all of our evaluation activities.

―A man received the cash for two months and later stops for over seven month. When he inquired, he was told that he had been dropped from the payment. Another lady said that she was dropped because she refused to pay two hundred Liberian dollars. Another older man said that one of the workers took his money for three months. One day he grabbed an SCT community worker and he even attempted to kill her for eating his money. But people around begged him to stop. That was how he started getting his money again.‖ (Stories from fieldwork)

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―In fact they took US$25 from my sister in law and yet her name did not come out. She had to cause serious confusion and her money was refunded. She is still not getting the cash transfer.‖ (Community FGD) ―I was registered but they left me out. They asked me for money but because I did not give them they left me out. My brother‘s wife gave them $25 but she is also not receiving anything. We have a teacher here who is making more than LD 5,000 monthly and his children are going to school, his wife doing good business but he is receiving the cash which is not supposed to be the case because the money is intended for the very poor not someone who is already working for government and getting paid.‖ (Community FGD)

This respondent is referring to the SCT enumerators which he claims asked him and his relative for money in order to be listed.

―Yes, most old people in the community were left out though they met the criteria to be a beneficiary… Maybe, they don‘t have special contact or have money to bribe the cash transfer team that was responsible for the selection in this town. An example is an old lady who lives right near me. She doesn‘t have anybody to help her; all of her children died. She was registered for the cash but after the process, her name was completely left out… They took bribes to put people names on the list. For example, there is a man here that I do remember. During the final listing, he was complaining that took money from him and did not see his name.‖ (Health Worker)

An agricultural worker explained that he believed the targeting process was unfair. However he also describes how SCT enumerators were paid but the payees were still left out. It appears as though in some cases, enumerators accepted bribes but did not enroll households, while in other cases, bribes did help households get selected.

―The people who were taking the names said the computer ate their names. They even give them hundred dollars but still their names did not come out. All I can say is that they know what they are doing. So, that‘s all I can say about the people that were left out… The houses were very many, I cannot count them, but all I can say is that targeting process was not too fair.‖ (Agricultural Worker)

One of the community FGD participants described a targeting problem and a complaint that the SCT secretariat never responded to:

―One of my sisters arrived for payment without her papers and was asked to go back to get them. Before she could return, they had replaced her name. She returned with her papers and they told her that her name had gone missing from the list and there was nothing they could do…We forwarded a complaint to the leaders of the town who extended it to their boss… Interestingly, all complaints fell on deaf ears and nothing was ever done up to the present. I just told her to forget about it.‖

There were complaints about the targeting process and instances of bribery from intervention households. This may be explained by the fact that initially, enumerators were hired on an ad hoc basis and received irregular pay. However, we are unable to quantify the extent to which this occurs in this study. Emotional Blow of Not Being Chosen Among people and households that met the program‘s criteria but were not selected, there was a powerful emotional reaction to not being selected. Although most people explained that they believe God made the decision and their ―time will come,‖ others responded with more desperation.

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―…because if you went for something and you are expecting to get or benefit from it and it does not work you feel very bad and frustrated and maybe want to kill yourself. I feel that most of the people of the people that were denied are people that are suffering more than some of the young people that receive the money.‖ (Male, Age 70, Household size=8, Intervention Household) ―Can you imagine that there was an old lady in my house who actually needed the cash and was denied? … I do not know why… I felt very bad. Here is a very old lady who does not have a husband, nowhere to stay. I accommodated her in my house. I was taking care of her with everything and they left her out. I accommodated her because there was no one to help her and I could not just sit and do nothing… Unfortunately she died… I am not a medical person... She was not sick. Neither did she complain about anything. She had grieved about her name being deleted from the program… I believe it played a part on her death and she felt abandoned by the government.‖ (Community FGD) ―There will be confusion if they come for the second time and leave people out. People are hoping to be part of the program in the second round and if they are left out there will be serious mixed feelings among us. It will be like the program is not fulfilling its objective because the people who are poor are not benefiting.‖ (Community FGD)

―I feel very bad because I am too old. Why didn‘t they take me? Those that they took are just better than me. I am also suffering like them. So, they are supposed to take me and give me some of the money… Why should those people just take a few people and leave me out? In fact I am suffering even more than those that are getting the money… they took all our names together and that means they know that I am suffering, why should they choose some people and give them money? Those that are getting the money, I can see their lives going up.‖ (Male, Age 86, Household size=1, Comparison Household)

Jealousy Among participants in the focus group discussions with community members, some, but not all participants reported feeling jealous.

―I am actually catching hard times since I had two operations which cannot allow me to do hard work. When I see those that are receiving the money and their lives are improving while mine is getting worse I feel jealousy. Not to harm them but to be like them; to be part of those that are getting the cash transfer for my own life to change like theirs.‖ (Community FGD) ―Many really expected their names to be on the cash transfer but were left out. This has caused jealousy amongst us in this town.‖ (Female, Age 38, Household size=7, Intervention Household) ―There is jealousy because most of the people were left out… I have two aunties of about the same age. They are very poor but they were all left out. We do not have a problem because some people are receiving but the people who were selecting beneficiaries were selecting based on the money they were receiving and maybe by family line.‖ Another participant followed: ―Yes there is jealousy because of how they made their selection. They came and registered all of us here. They said they were looking for widows, old people etc. My old ma registered but when they came for verification, they called the old lady and then they said she does not have gray hair and for that reason she does not qualify. She was left out of the program. Yet some people younger than her are receiving the money.‖ (Community FGD)

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In fact, some non-beneficiaries felt if they were given the chance to become beneficiaries they would aim to have greater impacts in their households than current recipients:

―There is no jealousy among us… Those guys came and told us that only some people will benefit from the program and that was what happened.‖ Another participant said: ―If those that did benefit from the program were not using the money wisely then I would have been jealous. Since it is used wisely, I want to be a part of the program, when I see others providing for their household especially cash from the program, I want to do more than what they are doing.‖ (Community FGD) “For the families that are receiving the cash transfer, life has improved. Their children are healthy. They wear good clothes. They look good among their friends. Like before we were in the same shoes but now they have left us here. I thank God for them, at least their lives have improved now…For me I will say yes, of course I was left out, but I think those that were chosen were the right people because they had nothing. But now when you see them you can feel proud. For me, I want to be like them but everything has its own time.‖ (Male, Age 87, Household size=11, Comparison Household)

CONCLUSION

Once again, the purpose of the external evaluation was first, to assess the situation of cash transfer beneficiary households compared to non-beneficiaries using a cross sectional, mixed methods study design. Resource and time constraints and data limitations precluded conducting a longitudinal study or using a different design. Still, we assessed food security, diversity, and stores; educational enrolment, attendance, and perceptions of performance; child labor; health, hygiene, and health-seeking behavior; asset ownership; housing quality; household expenditures and use of cash transfer; and the well-being of household members. The second objective was to assess the SCTP‘s targeting procedures to determine whether the process is transparent, fair, and implemented as envisioned; whether cash transfer recipients meet the eligibility criteria of being ultra poor and labor constrained; and whether eligible households were omitted from the SCTP. Strengths and Weaknesses This study has several strengths and weaknesses. The first weakness is that the study design is not a longitudinal randomized control trial with baseline and follow up data among randomly selected groups. Instead, we compared the cash recipients to households that were identified by Social Cash Transfer Secretariat as poor but ineligible to receive the transfer because they were not labor constrained. Of course in some cases the comparison households were labor constrained. Still, this study cannot provide impact estimates that are directly attributed to the cash transfer because we do not have comprehensive baseline data which would be necessary to measure change over time. In this study, we randomly selected households from the Secretariat‘s rosters in order to create plausible study groups and reduce selection bias. However, we know that information in the rosters is unlikely to be completely accurate, given the targeting problems that we documented. Further, the comparison group is not an exact counterfactual because, according to the Secretariat, all of the households that met the program‘s criteria were included in the program. Thus, the control group households were slightly better off than the intervention households before the cash transfer began as some households in the control group had labor so they were not as demographically, nor economically vulnerable as the intervention group. Intervention households should have been worse

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off at program inception (if they met the eligibility criteria), so that if they are better off at the time of the study‘s data collection activities, it implies that the positive differences were caused by the cash transfer. While there were additional safety net programs in operation during the time when recipient households received cash transfers, there were few differences between intervention and comparison households with regards to receiving other safety net programs. So it is unlikely that these programs explain the between group differences that emerged in the survey. In summary, the differences between the intervention and comparison households, such that intervention households have better outcomes, can likely be attributed to the cash transfer, but we still cannot say how much of the difference is due to the transfer given the study design, which was cross-sectional, rather than longitudinal. We created a counterfactual comparison group, but this was not a randomized control trial. An additional study weakness is that some of the interview respondents were very old and struggled to answer questions. We sought help from family members who were generally able to answer questions if the main respondent found the interview difficult. Finally, data collection occurred between September and November 2011 during the presidential election season. We were required to break for one week while voting took place and the country focused on the election. It is unclear whether the election biased responses in one way or another. However, we were sensitive to the political situation and rescheduled interviews when necessary, dressed unobtrusively, and probed and verified answers to ensure accuracy. This study also has a number of strengths. The quantitative survey was comprehensive and contained many questions which allowed our team to verify answers by asking similar questions in different ways. Liberians comprised the field team, with two highly trained supervisors and two field managers. We piloted surveys, provided feedback to interviewers, reviewed transcripts and surveys daily and provided on-going on-the-job training as needed. We also trained interviewers to observe clues within households to verify reports of food consumption, asset ownership, school attendance, productive activities, housing improvements, and household demographics. The team was trained to probe respondents if there were any inconsistencies within answers. The study design combined quantitative and qualitative activities in order to yield insights into complex phenomena, obtain a wide range of perspectives and confirm and verify findings. We included respondents of all ages, economic levels, and occupations. We were able to ask questions iteratively so that if we learned of an important issue, we were able to return to the study location at different times and further inquire about the issue. The qualitative interviews were flexible so that the field team could pursue interesting and important themes in as much time as they needed to fully understand the perspective of the respondent or the focus group participant. Daily debriefing sessions allowed the field team to discuss interviews so that the rest of the team could inquire about various phenomena in subsequent interviews. Summary of Findings

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Impacts Bomi is among the poorest counties in Liberia. The poverty rate is high and the impact of war is visible. Infrastructure is inadequate such that are insufficient schools, health centers, skilled health professionals, water and sanitation systems, roads and bridges, and access to technology. The war left many women widowed and children orphaned. Still, despite the difficult context, we found important differences between the intervention and comparison groups in the quantitative survey. In qualitative interviews and focus group discussions, the positive outcomes in intervention households were consistently attributed to the cash transfers. Intervention and comparison household heads, children, key informants and community members all described positive impacts within recipient households. Health: Intervention household heads reported better health among adults and children and health seeking behaviors than comparison household heads. Although intervention adults were more likely to seek care if sick, there was not a statistically significant difference in healthcare expenditures between groups. Still, intervention respondents were more likely than comparison respondents to report that healthcare was more than or just enough. Also, there were few differences between households in reported hygiene behaviors. The health impacts were confirmed by the health care workers and others in the key informant interviews, who reported seeing important improvements among cash recipients. Many respondents attributed better health to more and better food consumption, access to healthcare, the use of mattresses, which can reduce sicknesses, and hope for the future. Education: Intervention respondents reported higher rates of school enrolment than comparison respondents, as well as reduced absences and positive changes in performance. We found that differences in education were driven by the fact that intervention girls had higher enrolment and better school attendance than comparison girls and appeared to have benefited even more than boys. The education findings are confirmed in the qualitative data, except for in some households that receive small transfers, where children live with more distant relatives such as aunts or uncles, and within some households where the transfers are misused. Food Security: Intervention households reported better food security than comparison households. They were more likely than comparison households to report consuming at least two meals per day and feeling satisfied after meals. Although there were no differences between the groups in the food diversity score, intervention households consumed more items per food group than the comparison households, such as more types of vegetables, meat or fish items, dairy products and grains. The intervention group also had food stores for longer than the comparison group. Community members and key informants consistently described how many transfer recipients were looking better because they were well fed. Assets Ownership: The comparison group was more likely to own some assets, such as pails and buckets and metallic pots, which may indicate that they were in a better economic situation prior to the transfer than the intervention group, which we would expect. However there were few differences and the intervention group owned more of several items than the comparison group, including metallic plates, pails and buckets, and mats. The intervention group was also more likely to own a bed and mattress, which they had recently purchased. These findings were verified in the qualitative interviews and discussions.

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Household expenditures: Household expenditures for food and non-food items were statistically different and higher in intervention versus comparison households. Further, the intervention group was much more likely than the comparison group to report positive economic changes in the household over the past year. Some intervention households also described how they maximized the transfer by starting a business with the money. While many businesses were successful, in some cases children were required to perform heavy labor in order to help family members with the business. Housing: The intervention group was much more likely to report that housing was adequate compared to the non-recipient group. The intervention group reported important housing improvements, including reduced leaks and better quality roofing, walls and floors. In qualitative interviews and discussions, many respondents described all of the housing improvements that intervention households were able to make. These improvements were frequently linked to health improvements. Psychosocial wellbeing: Finally, intervention respondents reported improved satisfaction with life and greater hope for the future than comparison respondents. While the intervention group was emotionally boosted by the transfer, the comparison group was deflated when they learned that they would not be included in the Program. Some respondents contemplated suicide. Nevertheless, the majority of respondents believe that God is looking out for them, and if it is his will, they will be selected in the next targeting cycle. Heterogeneous impacts: Despite the positive study findings, there were important differences within the intervention group, such that households receiving small transfers experienced many fewer impacts. Intervention respondents and children expressed frustration with small transfers (i.e. such as LD700 or LD1000), particularly when not all children in the household could attend school due to lack of funds. Key informants confirmed that this was a serious issue. Still it is not clear whether people joined the household after the transfer level was set, recipients were only receiving a portion of the transfer that they should receive, whether the transfer size was adequate, or whether they had used the transfer on other purchases and had not yet figured out to how to manage all of their expenses. Undesirable uses: In the qualitative interviews and discussions, respondents provided anecdotes of recipients using transfers in non-socially desirable ways. While the number of recipients that misuse the transfer or use the transfer on socially undesirable expenditures, such as alcohol, gambling and prostitutes, appears to be low, it is difficult to estimate the extent of the misuse in this study. Nevertheless, there are recipients using the transfer for these items in several clans. In some households, adults are not using the transfer to enroll children in school despite the fact that their children want to enroll and attend regularly. The community members who observed these situations were frustrated and did not believe anything would be done about misuse. This perceived unfairness and misuse has affected public opinion about the SCTP, which is a threat to the program‘s scale up and sustainability. For SCTPs to be politically feasible, community members and leaders must believe that the right households are selected to receive the transfer and that they are using it to improve the health and human and economic development of household members.

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Community level impacts and impacts on the local economy: We were able to find evidence of the myriad of ways in which the cash transfer generates impacts on communities and businesses. The transfer reduces the burden on community members who provide food or other assistance to poor households. In fact some transfer households transform from households that begged to households that provided assistance within communities. Informants described how the improved situation of many recipients brought pride to the entire community. One respondent described positive competition such that transfer households made other households want to work harder to try to reach the level that the recipients were achieving. Transfer households were regular customers at many businesses as they purchased items and services, which contributed to business growth. Business owners reported that they were coming to rely on the cash households as important customers for their monthly sales. Recipients also created employment opportunities with the transfer and made goods easier to obtain when they started local businesses in their communities. Problems with the payment process: The two problems with the transfer program that intervention respondents and children frequently mentioned were the old torn bills, which could not be used and the distance to some pay points, which made picking up the transfer difficult. The situation of the control group: The interviews with comparison households and key informants and discussions with children and community members revealed that many households in Bomi are extremely poor and destitute such that families are still going hungry and eating poor quality foods, lacking adequate housing, and are unable to send children to school. Moreover, children in comparison households perform harmful work, mothers stint on food, grandparents struggle to provide for children, and entire families get sick from sleeping on the wet ground without mattresses. While we cannot quantify the exclusion error in the SCTP, it is clear that there are extremely poor households that are also labor constrained that are not cash transfer beneficiaries.

Targeting In the quantitative survey, we found some intervention households that did not meet the eligibility criteria (inclusion error) and many households in the comparison group that did meet the eligibility criteria (exclusion error). This study does not allow us to quantify the inclusion and exclusion error because we do not have accurate data at baseline or before the cash transfers were paid. In other words, we do not have baseline economic data to identify extreme poverty and the demographic situation in households may have changed over the past year. Nevertheless, the study findings indicate that the targeting procedures must continue to be reviewed and revised in order to reduce fraud, errors, and corruption. For example, we heard reports that SCTs coached households to respond to questions in order to boost chances of selection and demanded bribes. We also heard that households that were not selected or removed from the program for arbitrary reasons (i.e. hair not grey). In some cases, households were left out of the initial listing. Further, grievances and problems were not heard or rectified. Throughout study communities, while all respondents were familiar with the program, many were unclear about the eligibility criteria. In some cases, they were unable to question decisions because they did not have adequate information. Community members accepted responses such as ‗the computer ate the names‘ without understanding why households were included or excluded. While people wanted to express grievances, there was no formal grievance procedures or ombudsman and they did not receive responses when complaints were made to SCT enumerators or officials.

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Recommendations The study findings provide ample evidence that for the majority of cash transfer recipients, the impacts are transformative. Previously destitute households are able to make significant improvements in their lives. They improve their health, food security, children‘s education, asset ownership, housing, and these impacts spill over into communities and local economies. Still, we documented important threats to the program, such as misuse of the transfer, recipients concerns, variation in impacts and problems with the targeting procedures. Consequently, below we offer recommendations for programmatic improvements so that the SCTP yields the intended impacts as it scales up to and throughout additional counties and aims to be a sustainable social protection program. Recommendations are suggested to improve the 1) SCTP‘s operations 2) targeting procedures and 3) impacts. We also urge the Government of Liberia, UNICEF Liberia and other stakeholders to continue to learn through monitoring and evaluation activities and to develop a full social protection system. To improve SCTP Operations, we suggest the following:

x Develop and implement a full monitoring system designed with checks and balances to regularly monitor all program activities. The system must have feedback loops for information to stimulate continued programmatic improvements. Regular but unannounced monitoring of SCTPs can reduce instances of bribery. Community outreach activities should be implemented to identify households that may have been overlooked during the targeting activities. Monthly SCTP reports should be submitted and scrutinized to understand field challenges so that feasible solutions can be devised and implemented.

x We strongly recommend using multiple communication media to publicize aspects of the program, including the targeting procedures, eligibility criteria, payment levels, and expected uses of the cash. There is absolutely no empirical evidence to suggest that keeping programmatic information secret is an effective strategy to reduce fraud or corruption. Therefore, we suggest clarity and transparency around the SCT programmatic components which is proven to reduce fraud and corruption.

x Empower community members to observe the process and report fraud or targeting errors. x Spot check and monitor SCT staff that list households to reduce error and corruption. There

is an increased opportunity for fraud and corruption when communities do not fully understand the targeting criteria and program. While there is a risk that SCT enumerators or monitors could coach households or that households may commit fraud in order to obtain the cash, this could be reduced through better monitoring. Although the costs of improved monitoring have not been estimated in this report, the current approach, when further scaled throughout the country, risks serious inclusion and exclusion errors.

x Reduce misuse of the cash transfer. While attaching conditions to cash transfer programs has generally not been welcomed in many African countries because of low capacity to monitor conditions and inadequate infrastructure to deliver services, some countries (e.g. Kenya and Uganda and others) are empirically testing and comparing the costs and burden of conditions within cash transfer programs. It may be worth considering some conditions in Liberia to reduce the use of transfers on socially undesirable expenses. Currently, there is a risk that misuse may undermine the political feasibility of the program. It may also encourage misuse

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among other recipients if there is a not a social norm to use the money wisely. If a culture of misuse forms, it may encourage people to ‗game‘ the system, which they view as broken. This could further crowd out the poorest households that need the social protection support.

x Establish and publicize grievance procedures so that there is a process for citizens to report perceived problems with the program. Problems should be documented and responded to appropriately. Grievance systems are not difficult to designxxvi, however, they do require staffing to ensure that problems and grievances can be submitted and that there is a process to respond to them.

x Program implementers should work closely with banks to reduce and eliminate the bank notes that are torn and unacceptable so that recipients can use the full amount of transfer that they should receive.

x While the logistics of paying households in Liberia are challenging because of distance between clans, the state of roads and bridges, the cost of fuel, and vehicle limitations, implementers should consider adding pay points in clans where recipients must travel for hours in order to pick up their money. In some cases, obtaining transfers places a significant burden on elderly and chronically ill people.

To improve the program‘s targeting procedures and outcomes, we suggest the following:

x Add additional checks and balances to the current targeting process in order to reduce the ability of SCT enumerators or monitors or community members to coach households or to require and accept bribes. The SCT Secretariat could arrange spot checks and visit households to ensure that eligible households are chosen and ensure that excluded households do not meet the Program‘s eligibility criteria.

x Ensure that there is adequate staff in place at all levels in order to ensure quality and fairness as the program expands. The SCT Secretariat and staff must allocate more time to monitoring activities, ensuring that the right households are chosen, and grievances are documented and rectified. To their credit, the SCT Secretariat office manages a wide range of activities. However, the work burden may be too great to manage the range of challenges that are inevitable in a country where the majority of people are poor, civil servants are not well paid and often paid late. By ensuring adequate staffing levels, the SCT office can allocate more time to monitoring activities, ensuring that the right households are chosen, and responding to grievances. Additionally, the informal and adhoc nature of the enumerators led to errors and the exclusion of households that met the eligibility criteria.

x Develop additional methods to ensure that households are not overlooked and thus excluded from the transfer, particularly in hard to reach locations. We frequently heard of households that were not included because they were not listed or were not home when the SCT enumerators did their listing. We suggest using radio and other methods to build awareness of the targeting procedures as well as encouraging local leaders to be more aware of households that might meet the criteria but are difficult to find or visit.

x We strongly encourage Program implementers to examine whether additional households could be included in the Program because we encountered a number of families that met the eligibility criteria but were excluded, despite their destitute circumstances.

In order to maximize Program impacts, we recommend the following actions: x Provide business training skills to interested cash transfer households. Some recipients

established businesses on their own and were successful while others encountered problems or took on strenuous businesses that were a burden on children and adults. To maximize

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successful businesses established by cash recipients, a partnering organization could provide business training, assist with a market analysis to determine which businesses would be the most successful and help recipients with accounting and other business practices.

x Households should be sensitized to the problems associated with child work, particularly in Liberia where children burn coal, mine and do other dangerous work in order to earn money for food and schooling. While child work in poor households without cash transfers may be inevitable in the absence of additional social protection programs, in cash transfer households, a condition of cash may be that children should not do harmful or dangerous work.

x Program implementers should consider launching a social norm campaign to build the culture of using transfers appropriately. Publicizing the positive uses of cash transfers can generate healthy competition, inspire recipients and shame those who misuse the transfer into using the transfer for food, health, improved housing and education.

x Program implementers should further link to health services, education and agricultural projects and other sectors to increase the likelihood of a range of positive impacts. While the SCT office is at capacity, there are community based organization and non-governmental organizations that could provide additional services to cash recipients who are an active audience during monthly pay points.

x We suggest assessing how to further assist one person households that receive LD700 per month. For example, if the Secretariat or a partnering organization was able to link multiple one person households together through a savings group (susu) these individuals might be able to pool money for greater impacts. Reassessing the transfer amount may also be necessary. The trade-off between fewer households with larger benefits versus more households with smaller benefits is a serious question for debate.

Finally, given the widespread poverty in Bomi County and throughout Liberia and the number of households in a destitute situation, further developing a responsive, reliable Social Protection system is essential to the human and economic development of Liberia. We found many households without labor that should be included in the cash transfer Program and we encountered many extremely poor households with labor that require appropriate social protection programs such as cash for work programs. As the SCTP is scaled up throughout Liberia and the Social Protection system is further developed, we strongly recommend that stakeholders throughout Liberia continue to prioritize evaluation research to determine whether programs and policies are effective, to obtain impacts estimates, to reduce threats to program scale up and sustainability, to test and assess new and improved approaches, to determine what impacts cost, and to compare the costs of different approaches through a cost effectiveness analysis in order to address vulnerability and reduce poverty.

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xixFiszbein, A. and Schady, N. with Ferreira, F., Grosh, M, Kelleher, N., Olinto, P. and Skoufias.E.

"Conditional Cash Transfers for Attacking Present and Future Poverty." Development Research Group, The World Bank, Forthcoming 2008.

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External Evaluation of the Bomi Social Cash Transfer Pilot Final Report … · 2019-06-07 · i External Evaluation of the Bomi Social Cash Transfer Pilot Final Report Dr. Candace