Since 1990, natural disasters have affected more than 200 million people every year (Leaning & Guha-Sapir, 2013). 'In addition, violent conflict affects the lives of roughly 1.5 billion people across the globe every year (World Bank, 2011). To mitigate with these disasters 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. Increasing use of cash-based approaches has been accompanied by efforts to evaluate cash-based interventions and develop recommendations for implementation in a range of settings. Systematic reviews of evidence in humanitarian settings are, however, relatively rare, and this is the first systematic review of the effects of cash-based approaches in emergencies to date.'
The primary objective of this review was to assess and synthesize existing evidence on the effects of cash-based approaches on individual and household outcomes in humanitarian emergencies. The secondary objective was to assess the efficiency of different cash-based approaches and identify factors that hinder and facilitate programme implementation.'
The authors included studies assessing the effects of cash-based approaches in humanitarian emergencies. They included published studies and unpublished studies from 2000 onwards. The authors searched the following databases: Academic Search Complete, ScienceDirect, Web of Science, Scopus, Econlit, IDEAS, MEDLINE, CINAHL, Embase, Latin American Virtual Health Library and so on. Two independent reviewers reviewed eligible abstracts. To identify an unbiased set of citations the authors identified studies in the grey literature from conference proceedings, databases of unpublished studies, and studies published in supplements, theses, and dissertations. In addition, the authors conducted forward citation-tracking of included studies in Web of Science, Scopus and Google Scholar, and also reviewed bibliographies from systematic and non-systematic reviews of cash programmes to search for additional studies that were not identified using search strategies outlined above. Two independent reviewers did the full text screening and data extration. Due to the differences in results a narrative syntheis for effects and efficiency of cash based approaches was conducted; the results of factors influencing implementation of cash-based approaches were synthesised descriptively. The authors also accounted for unit of analysis errors.'
Headline Findings: a summary statement
Findings suggest that cash-based approaches 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.
The authors included 113 records, seven were experimental or quasi-experimental studies (five unique studies), 11 were cost studies (ten unique studies), and 112 reported observational, qualitative or mixed methods studies reporting factors that hinder or facilitate programme implementation (108 unique studies). There was a relatively even distribution of contexts from which studies originated, with 32 per cent (n=35) of included studies conducted in conflict-affected populations, 37 per cent (n=40) conducted in settings affected by natural disasters and 35 per cent (n=38) in settings affected by extreme food insecurity. The studies covered Africa, the Middle-East, Latin America, Asia and Europe.
Implications for policy and practice
Effectiveness of cash-based approaches
Five studies assessed the effects of cash-based approaches, four of which assessed effects on household level food security outcomes.
Unconditional cash transfers and vouchers may improve household food security among conflict-affected populations and maintain household food security within the context of food insecurity crises and drought. Studies found that unconditional cash transfers led to greater improvements in dietary diversity and quality than food transfers. But food transfers were more successful in increasing per capita caloric intake than cash transfers and vouchers.
Unconditional cash transfers may be more effective than vouchers in increasing household savings, and equally effective in increasing household assets. Mobile transfers may be a more successful asset protection mechanism than physical cash transfers.
Efficiency of cash-based approaches
Ten studies assessed the efficiency of cash based approaches. Cash transfers and vouchers may be more cost-efficient than in-kind food distribution. Studies found that unconditional cash transfer programmes have a lower cost per beneficiary than comparison interventions (either vouchers, in-kind food distribution or both); and vouchers have a lower cost per beneficiary than in-kind food distribution.
Cash-based approaches may have positive economic multiplier effects. 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
Factors facilitating and hindering implementation of cash-based approaches
Evidence suggests that intervention design and implementation play a greater role in determining effectiveness and efficiency of cash-based approaches than the emergency context or humanitarian sector.
Specific factors shown to 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.
Implications for further research
Despite the widespread use and increasing number of evaluations of cash-based humanitarian assistance, there is a paucity of rigorous evidence. Further development of the evidence base, with more rigorous evaluations comparing the effectiveness of different cash-based approaches (or combinations of approaches) and transfer modalities, as well as standardized approaches to documenting and comparing both costs and benefits of cash-transfer and voucher programmes, is needed to further strengthen the evidence base in this area.