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Puett C, Salpéteur C, Houngbe F, Martínez K, N'Diaye DS, Tonguet-Papucci A. Costs and cost-efficiency of a mobile cash transfer to prevent child undernutrition during the lean season in Burkina Faso: a mixed methods analysis from the MAM'Out randomized controlled trial. Cost Eff Resour Alloc 2018; 16:13. [PMID: 29686539 PMCID: PMC5899398 DOI: 10.1186/s12962-018-0096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background This study assessed the costs and cost-efficiency of a mobile cash transfer implemented in Tapoa Province, Burkina Faso in the MAM’Out randomized controlled trial from June 2013 to December 2014, using mixed methods and taking a societal perspective by including costs to implementing partners and beneficiary households. Methods Data were collected via interviews with implementing staff from the humanitarian agency and the private partner delivering the mobile money, focus group discussions with beneficiaries, and review of accounting databases. Costs were analyzed by input category and activity-based cost centers. cost-efficiency was analyzed by cost-transfer ratios (CTR) and cost per beneficiary. Qualitative analysis was conducted to identify themes related to implementing electronic cash transfers, and barriers to efficient implementation. Results The CTR was 0.82 from a societal perspective, within the same range as other humanitarian transfer programs; however the intervention did not achieve the same degree of cost-efficiency as other mobile transfer programs specifically. Challenges in coordination between humanitarian and private partners resulted in long wait times for beneficiaries, particularly in the first year of implementation. Sensitivity analyses indicated a potential 6% reduction in CTR through reducing beneficiary wait time by one-half. Actors reported that coordination challenges improved during the project, therefore inefficiencies likely would be resolved, and cost-efficiency improved, as the program passed the pilot phase. Conclusions Despite the time required to establish trusting relationships among actors, and to set up a network of cash points in remote areas, this analysis showed that mobile transfers hold promise as a cost-efficient method of delivering cash in this setting. Implementation by local government would likely reduce costs greatly compared to those found in this study context, and improve cost-efficiency especially by subsidizing expansion of mobile money network coverage and increasing cash distribution points in remote areas which are unprofitable for private partners.
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Affiliation(s)
- Chloe Puett
- Research and Technical Department, Action Against Hunger, New York, NY USA
| | - Cécile Salpéteur
- 2Department of Expertise and Advocacy, Action contre la Faim, Paris, France
| | - Freddy Houngbe
- 2Department of Expertise and Advocacy, Action contre la Faim, Paris, France
| | - Karen Martínez
- Research and Technical Department, Action Against Hunger, New York, NY USA
| | - Dieynaba S N'Diaye
- 2Department of Expertise and Advocacy, Action contre la Faim, Paris, France
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Tonguet-Papucci A, Houngbe F, Huybregts L, Ait-Aissa M, Altare C, Kolsteren P, Huneau JF. Unconditional Seasonal Cash Transfer Increases Intake of High-Nutritional-Value Foods in Young Burkinabe Children: Results of 24-Hour Dietary Recall Surveys within the Moderate Acute Malnutrition Out (MAM’Out) Randomized Controlled Trial. J Nutr 2017; 147:1418-1425. [DOI: 10.3945/jn.116.244517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/31/2017] [Accepted: 04/27/2017] [Indexed: 11/14/2022] Open
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Tonguet-Papucci A, Houngbe F, Lompo P, Yameogo WME, Huneau JF, Ait Aissa M, Kolsteren P. Beneficiaries' perceptions and reported use of unconditional cash transfers intended to prevent acute malnutrition in children in poor rural communities in Burkina Faso: qualitative results from the MAM'Out randomized controlled trial. BMC Public Health 2017; 17:527. [PMID: 28558709 PMCID: PMC5450256 DOI: 10.1186/s12889-017-4453-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 05/18/2017] [Indexed: 11/26/2022] Open
Abstract
Background Acute malnutrition is a public health issue worldwide, and particularly in the Eastern region of Burkina Faso. Following a needs assessment, unconditional seasonal, multiannual cash transfers were implemented as a safety net to prevent childhood undernutrition. The objectives of this study were to explore the types of purchases made by beneficiaries of this cash transfer program and to understand the perceived effects of and changes induced by regular cash transfers in the daily lives of women, and at the household and community level. Methods The design of this study was a two-arm cluster randomized controlled trial. Qualitative data were collected each month during the cash transfer period for two years, leading to a total of more than 300 interviews and focus group discussions with various participants: beneficiary mothers, heads of households, mothers-in-law, co-wives, key members of the community, and participants of the control group. Results The two main types of expenses reported were food and health care for the child and the whole family. The program was also associated with positive perceived changes at the household level, mainly related to gender equality and improvement of women’s status, and has promoted an increase in dignity and social integration of the poorest at the community level through cash sharing. Unexpected effects of this program included some women planning new pregnancies and some individuals not expecting the transfers to end. Conclusion Although the transfers were unconditional, the cash was mainly used to improve the children’s and households’ food security and health, which correspond to two main underlying causes of undernutrition. Therefore, spending mainly in these areas can help to prevent undernutrition in children. Trial registration ClinicalTrials.gov, identifier: NCT01866124, registered May 7, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4453-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Audrey Tonguet-Papucci
- Research and Analyses Department, Action Contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854, Paris CEDEX 17, France. .,Department of Food Safety and Food Quality, Ghent University, Campus Coupure, A2.081, Coupure Links 653, B 9000, Ghent, Belgium. .,UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 16 rue Claude Bernard, 75005, Paris, France.
| | - Freddy Houngbe
- Research and Analyses Department, Action Contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854, Paris CEDEX 17, France.,Department of Food Safety and Food Quality, Ghent University, Campus Coupure, A2.081, Coupure Links 653, B 9000, Ghent, Belgium
| | - Palamanga Lompo
- Research and Analyses Department, Action Contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854, Paris CEDEX 17, France.,Action Contre la Faim
- ACF-Burkina Faso, Rue 13-22, P557 Zogona Zone du bois, 06, Ouagadougou 06, BP, 10221, Burkina Faso
| | | | - Jean-François Huneau
- UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 16 rue Claude Bernard, 75005, Paris, France
| | - Myriam Ait Aissa
- Research and Analyses Department, Action Contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854, Paris CEDEX 17, France
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Campus Coupure, A2.081, Coupure Links 653, B 9000, Ghent, Belgium
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Houngbe F, Tonguet-Papucci A, Altare C, Ait-Aissa M, Huneau JF, Huybregts L, Kolsteren P. Unconditional Cash Transfers Do Not Prevent Children’s Undernutrition in the Moderate Acute Malnutrition Out (MAM’Out) Cluster-Randomized Controlled Trial in Rural Burkina Faso. J Nutr 2017; 147:1410-1417. [DOI: 10.3945/jn.117.247858] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/21/2017] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
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Tonguet-Papucci A, Huybregts L, Ait Aissa M, Huneau JF, Kolsteren P. The MAM'Out project: a randomized controlled trial to assess multiannual and seasonal cash transfers for the prevention of acute malnutrition in children under 36 months in Burkina Faso. BMC Public Health 2015; 15:762. [PMID: 26253152 PMCID: PMC4529713 DOI: 10.1186/s12889-015-2060-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. METHODS/DESIGN The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries' self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families' expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed. DISCUSSION The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as delay in project implementation, switch to e-data collection and implementation of a supervision process. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT01866124, registered May 7, 2013.
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Affiliation(s)
- Audrey Tonguet-Papucci
- Research and Analyses Department, Action Contre la Faim, Paris, France.
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- AgroParisTech, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
- NRA, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
| | - Myriam Ait Aissa
- Research and Analyses Department, Action Contre la Faim, Paris, France.
| | - Jean-François Huneau
- AgroParisTech, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
- NRA, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- Child Health and Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium.
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