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Ghana LEAP 1000 Programme: Endline Evaluation Report

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Ghana
Sources
Govt. Ghana
+ 1
Date de publication
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FINAL EVALUATION OF GHANA SOCIAL PROTECTION PROGRAMME FOR INFANTS NOW AVAILABLE

PROGRAMME REDUCED POVERTY, IMPROVED ANTE-NATAL CARE BUT DID NOT REDUCE RATES OF STUNTING

(21 February 2020) An end line impact evaluation report has recently been completed documenting the various impacts found in Ghana's national unconditional cash transfer programme targeting young child health and nutrition outcomes in impoverished northern districts of the country.

The report of the Ghana LEAP 1000 is an extension of the country's mainstream LEAP programme, Ghana’s flagship social protection programme, which provides bi-monthly cash payments to extremely poor households in all districts of the country. While LEAP focuses on households with elderly, people with a disability and orphaned and vulnerable children, LEAP 1000 targets pregnant women and mothers with infants, to support the window of the first 1,000 days of life and thus alleviating household poverty and improve nutritional status of infants. In addition to the cash transfer, LEAP 1000 offers free registration in the National Health Insurance Scheme (NHIS).

THE EVALUATION: A QUASI-EXPERIMENTAL, LONGITUDINAL, MIXED METHOD DESIGN

LEAP 1000 was first piloted in ten districts in Northern Ghana in 2015. UNICEF Innocenti in collaboration with the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana, the University of North Carolina at Chapel Hill (USA), and Navrongo Health Research Centre, carried out a mixed-methods impact evaluation. Households applying to the LEAP 1000 programme were subjected to a proxy-means test. The impact evaluation compares households who were just below the proxy means test cut-off score (eligible for LEAP 1000) to those just above the cut-off score (not eligible for LEAP 1000). Households included as part of the evaluation sample were interviewed at baseline (in 2015) and end line (in 2017).

KEY RESULTS

LEAP 1000 raised consumption and decreased poverty. Despite decreases in overall consumption levels since baseline, treatment households spent more than the comparison group and had protective impacts against poverty as a result of the programme. In addition, LEAP 1000 positively impacted some dimensions of economic productivity and savings. LEAP 1000 did not increase fertility and did increase ANC visits from skilled providers. A cash transfer targeting pregnant women and mothers with children under one year of age may generate concerns of unintended fertility increases. There is no evidence of such an effect; rather, LEAP 1000 had a small but significant impact on reducing fertility. The programme did increase the likelihood of currently pregnant women to receiving antenatal care (ANC) from a skilled provider.

LEAP 1000 positively impacted social support of beneficiary women and reduced frequency of intimate partner violence against women but not perceived stress. These are general indicators of well-being, which may also impact child well-being and health through diminished care giving practices. Furthermore, there was no evidence of increases in spending on alcohol and tobacco as a result of the programme. LEAP 1000 facilitated linkages to NHIS by exempting beneficiaries from premiums. NHIS enrollment increased as a result of LEAP 1000. In terms of morbidity, while the programme did not have a significant impact on illness incidence of individuals, it did have a positive impact on health-seeking behavior, though only for adults.

Despite the focus of LEAP 1000 on the critical first 1,000 days of a child’s life, the programme did not have an impact one of LEAP 1000’s primary objectives, namely reducing child stunting and improving nutrition. Given that child nutrition and stunting are determined by a complex set of inputs, this result, combined with the lack of programme impacts on child feeding practices, drinking water and sanitation (some of the complex determinants of nutrition), suggest that cash and health insurance alone are not enough to reduce child stunting, and that complementary interventions may be needed.