Cash-based approaches in humanitarian emergencies: a systematic review

This Campbell systematic review examines the effectiveness, efficiency and implementation of cash transfers in humanitarian settings. The review summarises evidence from five studies of effects, 10 studies of efficiency and 108 studies of barriers and facilitators to implementation of cash-based humanitarian assistance. Studies assessing effectiveness of cash-based approaches were experimental and quasiexperimental studies. Studies analyzing efficiency were experimental, quasi-experimental or observational studies with a cost analysis or economic evaluation component. Studies examining barriers and facilitators included these study types as well as other qualitative and mixed methods studies. Unconditional cash transfers and vouchers may improve household food security among conflict-affected populations and maintain household food security among food insecure and drought-affected populations. Unconditional cash transfers led to greater improvements in dietary diversity and quality than food transfers, but food transfers are more successful in increasing per capita caloric intake than unconditional cash transfers and vouchers. Unconditional cash transfers may be more effective than vouchers in increasing household savings, and equally effective in increasing household asset ownership. Mobile transfers may be a more successful asset protection mechanism than physical cash transfers. Cash transfers can be an efficient strategy for providing humanitarian assistance. Unconditional cash transfer programmes have a lower cost per beneficiary than vouchers which, in turn, have a lower cost per beneficiary than in-kind food distribution. Cash transfer programs can also benefit the local economy. Voucher programmes generated up to $1.50 of indirect market benefits for each $1 equivalent provided to beneficiaries and unconditional cash transfer programmes generated more than $2 of indirect market benefits for each $1 provided to beneficiaries. Intervention design and implementation play a greater role in determining effectiveness and efficiency of cash-based approaches than the emergency context or humanitarian sector. Factors which influence implementation include resources available and technical capacity of implementing agencies, resilience of crisis-affected populations, beneficiary selection methods, use of new technologies, and setting-specific security issues, none of which are necessarily unique to cash-based interventions. Plain language summary Cash-based humanitarian assistance approaches can increase food security and are more cost effective than in-kind food transfers Both cash-based approaches and in-kind food assistance can be effective means of increasing household food security for people who live in areas of conflict. The review in brief Cash-based approaches have become an increasingly common strategy for the provision of humanitarian assistance. Both cash-based approaches and in-kind food assistance can be effective means of increasing household food security among conflict-affected populations and maintaining household food security among food insecure and drought-affected populations. Cash transfers are more cost effective than vouchers which are more cost effective than in-kind food assistance. What is this review about? This review assesses the effects of cash-based approaches on individual and household outcomes in humanitarian emergencies. It also assesses the efficiency of different cash-based approaches and identifies factors that hinder and facilitate programme implementation. What is the aim of this review? This Campbell systematic review examines the effectiveness, efficiency and implementation of cash transfers in humanitarian settings. The review summarises evidence from five studies of effects, 10 studies of efficiency and 108 studies of barriers and facilitators to implementation of cash-based humanitarian assistance. What are the main findings of this review? What studies are included? Studies assessing effectiveness of cash-based approaches were experimental and quasi-experimental studies. Studies analyzing efficiency were experimental, quasi-experimental or observational studies with a cost analysis or economic evaluation component. Studies examining barriers and facilitators included these study types as well as other qualitative and mixed methods studies. Unconditional cash transfers and vouchers may improve household food security among conflict-affected populations and maintain household food security among food insecure and drought-affected populations. Unconditional cash transfers led to greater improvements in dietary diversity and quality than food transfers, but food transfers are more successful in increasing per capita caloric intake than unconditional cash transfers and vouchers. Unconditional cash transfers may be more effective than vouchers in increasing household savings, and equally effective in increasing household asset ownership. Mobile transfers may be a more successful asset protection mechanism than physical cash transfers. Cash transfers can be an efficient strategy for providing humanitarian assistance. Unconditional cash transfer programmes have a lower cost per beneficiary than vouchers which, in turn, have a lower cost per beneficiary than in-kind food distribution. Cash transfer programs can also benefit the local economy. Voucher programmes generated up to $1.50 of indirect market benefits for each $1 equivalent provided to beneficiaries and unconditional cash transfer programmes generated more than $2 of indirect market benefits for each $1 provided to beneficiaries. Intervention design and implementation play a greater role in determining effectiveness and efficiency of cash-based approaches than the emergency context or humanitarian sector. Factors which influence implementation include resources available and technical capacity of implementing agencies, resilience of crisis-affected populations, beneficiary selection methods, use of new technologies, and setting-specific security issues, none of which are necessarily unique to cash-based interventions. What do the findings of this review mean? Unconditional cash transfers and vouchers can be effective and efficient ways to provide humanitarian assistance. Each assistance modality has different advantages and disadvantages that should be considered in the design of future interventions. However, no definitive conclusions on the effectiveness of cash transfer or voucher programmes could be drawn that are universally applicable for humanitarian policy. Further development of the evidence base, with more rigorous evaluations comparing the effectiveness of different cash-based approaches and transfer modalities, as well as approaches to comparing costs and benefits of cash-transfer and voucher programmes, is needed to further strengthen the evidence base. How up-to-date is this review? The review authors searched for studies published up to November 2014. This Campbell systematic review was published in December 2017. Executive summary BACKGROUND Humanitarian actors have a responsibility to ensure that assistance is provided in a way that minimizes risks and maximizes benefits to people affected by crisis. However, there are many challenges in evaluating ‘what works’ in addressing the needs of crisis-affected populations, and translating research evidence into practice in complex environments with limited resources. Humanitarian assistance has traditionally been provided in the form of in-kind goods and services: temporary shelters, food and non-food items, water and medical care. However, as the nature of humanitarian crises has shifted over the last few decades, cash-based approaches have become an increasingly common strategy for the provision of humanitarian assistance and are widely considered an appropriate, and sometimes preferable, substitute for in-kind assistance when conditions permit.