This study focuses on the impact of providing Essential Household Items (EHI) via cash vouchers for use at UNICEF-organised EHI fairs in the Democratic Republic of Congo for internally displaced people. This study provides evidence that the provision of EHI via vouchers and fairs causes substantial improvements in adults’ mental health, and moderate improvements in resilience and social cohesion.
In the Democratic Republic of Congo, humanitarian actors have been present for over 20 years due to ongoing-armed conflicts and low-state capacity. Acute crises such as population displacement and natural disasters exacerbate a situation of chronic vulnerability, especially among the rural population.
As of December 2017, the Internal Displacement Monitoring Center estimated that ongoing conflicts in North and South Kivu and an increase in inter-communal clashes in southern and central provinces had caused 4,480,000 people to be displaced from their homes. At that time, it was the highest number of internally displaced people (IDPs) in Africa. Most of these IDPs lack sufficient access to food, clean water, and sanitation facilities, and threats to security are pervasive.
The Rapid Response to the Movements of Population (RRMP) program conducts multi-sectoral needs assessment and responds to the humanitarian needs of households affected by population movement, whether they are fleeing from armed conflict or natural disasters, hosting displaced families, or returning to their home communities after such displacement.
RRMP8 (May 2017 – April 2018), the intervention phase under study in this report, provided humanitarian assistance to vulnerable populations wherever was necessary, especially in the conflict affected in the provinces of North Kivu, South Kivu, Ituri, Tshopo, Haut Katanga, Tanganyika, and the Kasai region. The RRMP8 budget was approximately 25 million USD and the program assisted nearly 1.4 million people. This evaluation focuses on IDPs in host communities and the communities who hosted them, rather than on returnees or IDPs staying in spontaneous camps or collective sites.
Based on gap analysis and vulnerability thresholds, RRMP can potentially provide multisectoral humanitarian assistance in the following sectors: 1) Essential Household Items (EHI), 2) health and nutrition, 3) child protection and education, and 4) water, sanitation and hygiene (WASH).
This study examines RRMP assistance in the form of EHIs. In humanitarian assistance parlance, EHI—or NFI (Non-Food Items) as is more commonly used – generally refers to the items that individuals and households affected by a disaster will need to carry out essential daily activities. RRMP and the NFI/shelter cluster in the DRC typically focus on EHI to assist people with clothing themselves; preparing, serving, and storing food; collecting, storing, and using water for hygiene and cleaning activities; sleeping; and in some cases essential livelihood activities. This study focuses specifically on vouchers for EHIs that were used at voucher fairs organized by RRMP. The total voucher amount ranged from USD 55-90 per household, depending on the specific intervention’s budget and the size of each household.
The key research question is: What is the effect of humanitarian assistance (specifically the provision of vouchers for EHI) provided to recently displaced or returned persons, and vulnerable host families, on health and well-being?
This study adds to the small but growing evidence base for humanitarian assistance and will provide information that should help improve a flagship UN program with a strong record of learning and adaptation that has been expanded to Central African Republic, Iraq, South Sudan, and Yemen.
This study involved a randomised controlled trial (RCT) of vouchers for EHI, complemented by focus group discussions (FGD). At each site, RRMP8 provided vouchers for EHI to vulnerable households (both displaced and local). For the study, an additional 976 households who were just below the vulnerability threshold for receiving RRMP assistance were enrolled. Of these, 488 were randomly assigned to the EHI voucher group and 488 to control.
In terms of the final study sample: 856 households were interviewed just before the EHI fair (baseline survey). 434 households from the voucher recipient group were interviewed just after the EHI fair (midline survey, 3-8 days after the baseline). And 769 households were interviewed five-to-six weeks after the baseline survey.
The baseline and endline interviews lasted about one hour each, and included multiple questions about each of the four outcome groups, along with questions about basic demographic and socioeconomic information.
The endline survey also included rapid diagnostic tests for malaria, haemoglobin measurements, and height, weight, and mid-upper arm circumference (MUAC) measurements of all children aged 6-59 months. The shorter midline survey focused on which items were purchased at the fair, and at what price.
Alongside the endline survey, 20 focus groups with eight people each were conducted across the seven sites, 10 FGDs with internally-displaced persons (IDP) and 10 FGDs with locals (including hosts of IDPs). About half of the FGD respondents had participated in EHI voucher fairs, and half had not.
The study finds strong effects of EHI vouchers on adult mental health, and to a smaller degree on resilience and social cohesion.
Specifically, large improvements in mental health, by about 0.35 standard deviations, and moderate increases in resilience (0.18 standard deviations) and social cohesion (0.15 standard deviations) were observed. This is encouraging as EHI items seem to have increased both coping and consumption. Both life satisfaction and reduced anxieties, on the one hand, and investments in assets, food security and financial deepening (through incurring debt), on the other hand, are predictive of longer run consumption and incomes, suggesting that the benefits of EHI vouchers may persist beyond the five-to-six week period measured here.
There was no increase in community tensions or conflict. In fact, there was a marked increase in social capital for recipient households.
The qualitative evidence reinforces the positive effects of the EHI, with almost all recipients reporting that EHI were beneficial. There were also many reports of sharing EHI, which supports the increase in social cohesion. In addition, households sold EHI to meet more urgent needs, such as food and medicine, both of which were major concerns for respondents. The FGDs also revealed, however, that the targeting and selection process was poorly understood.
The study finds no evidence for an impact of EHI vouchers on child physical health. This may be due to the short time duration between receiving vouchers and the endline survey, the type of EHIs purchased, how EHI were used, or other reasons, which provides an impetus for essential future research.
Overall, the results of this study support the claim that humanitarian assistance can cause important increases in well-being in the short term. The study recommends continued funding for the RRMP program, along with a call for additional research to continue to innovate and improve.