Policy objectives and evidence of impacts

Social protection can have a wide range of objectives and impacts, from food security, access to services, gender equality, and state-building, to social transformation. The emphasis in developing countries has been on poverty and vulnerability reduction, and human development, for which there is good evidence. There is less evidence on longer-term developmental impacts such as sustainable graduation from poverty, or better job prospects. The choice of objective depends on a range of factors.

Below are a selection of the objectives and impacts of social protection programmes.

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Poverty and vulnerability

The primary aim for most social protection programmes is to reduce poverty and vulnerability. As noted above, different stakeholders have different conceptual approaches for achieving this. There is strong evidence that social protection can have significant impacts on both poverty and vulnerability. There is evidence of the positive effects of social transfers (in particular, social pensions and cash transfers) on poverty reduction and in reaching the chronically poor (Barrientos & Niño-Zarazúa, 2011). There is also evidence from Latin America that social transfers can reduce inequality (Fiszbein & Schady, 2009). There is some evidence that social protection also has negative effects on poverty indicators (Hagen-Zanker et al., 2011).

Key texts

Barrientos, A. & Niño-Zarazúa, M. (2011). Social transfers and chronic poverty: objectives, design, reach and impact. Chronic Poverty Research Centre Report.
The report focuses on three policy questions: first, do programme objectives address chronic poverty? Second, are programme design features – the identification and selection of beneficiaries, delivery mechanisms and complementary interventions – effective in reaching chronically poor households? And third, do social assistance programmes benefit the chronically poor? The broad conclusions are that social protection does reach the chronically poor, and that there are significant improvements in poverty reduction. The report examines the types of programme and design features which are shown to have more or less impact.
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Hagen-Zanker, J., McCord, A. & Holmes, R. (2011). Systematic review of the impact of employment guarantee schemes and cash transfers on the poor. London: ODI.
This review considers 37 studies with evidence on poverty indices, income, and expenditure. There are significantly more studies available on cash transfers (CTs) than on employment guarantee schemes (EGSs). Both CTs and EGSs have a predominantly, but not exclusively, positive impact on reducing poverty; 39 studies found positive impacts from either CT or EGS participation, and nine found negative impacts, generally from high-quality studies.
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Education

Many social transfers seek to improve children’s schooling, to invest in human capital and to break the intergenerational transmission of poverty (Barrientos & Niño-Zarazúa, 2011). Impacts of social protection on schooling have included, at both primary and secondary levels, increased enrolment, attendance, better grade progression, and decreased drop-out (Barrientos & Niño-Zarazúa, 2011). A systematic review shows that both CCTs and UCTs have positive effects on schooling enrolment and attendance. The effect sizes are larger for CCTs than UCTs, but the difference is not significant (Baird et al., 2013). Social protection programmes which do not focus explicitly on schooling also have positive effects, for example, pensions are often used to pay grandchildren’s school fees (Barrientos & Niño-Zarazúa, 2011).

While these immediate impacts are well-documented, there is less evidence on whether increased schooling translates into improved knowledge and educational attainment, better labour market outcomes, or an escape from chronic poverty (Barrientos & Niño-Zarazúa, 2011). The evidence on the effectiveness of CCTs and UCTs on improving test scores is small at best. More research is needed that looks at longer-term outcomes (Baird et al., 2013).

Key texts

Baird, S., Ferreira, F. H. G., Özler, B. & Woolcock, M. (2013). Relative Effectiveness of Conditional and Unconditional Cash Transfers for Schooling Outcomes in Developing Countries: A Systematic Review (Campbell Systematic Reviews 2013:8). The Campbell Collaboration.
This systematic review provides evidence on the effectiveness of CCTs in improving schooling outcomes. The findings suggest that both CCTs and UCTs have a significant effect on enrolment. CCTs increase the odds of a child, aged between five and 22, being enrolled in school by 41 per cent and UCTs by 23 per cent. The effect sizes for enrolment and attendance are always larger for CCT programmes than UCTs but the difference is not significant. While interventions with no conditions or some conditions that are not monitored have some effect on enrolment rates (18-25 per cent improvement), programmes that are explicitly conditional, monitor compliance and penalise non-compliance have substantively larger effects (60 per cent improvement). Unlike enrolment and attendance, the effectiveness of cash transfer programmes on improving test scores is small at best.
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See also: Haider, H. (2010). Social Protection and Access to Education (GSDRC Helpdesk Research Report). Birmingham, UK: GSDRC, University of Birmingham.

Health

Social protection programmes can aim to improve health directly, e.g. by conditioning programmes on attendance at health services, or indirectly, e.g. through supplemented income and therefore consumption (Barrientos & Niño-Zarazúa, 2011). There is strong evidence on the positive health impacts of cash transfers and health insurance programmes, particularly on children’s and maternal health outcomes. Most of the evidence comes from CCTs in Latin America, since these are often conditioned on health investments. Many CCT programmes include a number of health components, including incentivising attendance for health education, measurements of height and weight, immunisations and nutritional supplementation.

CCTs in Latin America have had strong impacts on improving health care check-ups for children, children’s morbidity rates and immunisation, among others (Barrientos & Niño-Zarazúa, 2011). CCTs have also improved maternal health (Barrientos & Niño-Zarazúa, 2011). A systematic review concludes that CCTs appear to be effective in increasing the uptake of preventative health services, and encourage some preventative behaviours (Lagarde et al., 2009). The link between CCTs and health outcomes is less clear. In some cases programmes have noted improvement in health outcomes, though it is unclear to which components these positive effects should be attributed (Lagarde et al., 2009). There is some evidence to suggest that MICs have been more successful at meeting health needs than LICs, as LICs often do not have the supply capacity to meet demand (Barrientos & Niño-Zarazúa, 2011).

Key texts

Lagarde, M., Haines, A. & Palmer, N. (2009). The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No. CD008137.
The systematic review includes ten papers reporting results from six intervention studies. Several CCT programmes provided strong evidence of a positive impact on the use of health services, nutritional status and health outcomes, assessed by anthropometric measurements and self-reported episodes of illness. Attribution to cash transfers specifically is difficult to ascertain. Several studies provide evidence of positive impacts on the uptake of preventive services by children and pregnant women. It found no evidence about effects on health care expenditure.
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Nutrition

In theory, social protection has the potential to protect or improve the nutritional status of target groups in a number of ways. Improved economic status could enable households to access more nutritious diets, healthcare, and education, and to make improvements in water, sanitation and hygiene. All of these could help people remain well-nourished and to grow and develop properly. However, the evidence for the impact of social protection on nutrition remains mixed.

Evaluations of conditional cash transfer programmes in Latin America found that some, but not all, improved child growth (i.e. height). Only one looked at impact on wasting, but found no impact (Lagarde et al., 2009). These studies found that the age of the child and access to health care are more important for child growth than conditionalities (Manley et al., 2012). It has been suggested that ‘nudging’ beneficiaries (i.e. emphasising the importance of good nutrition but not attaching conditions) might be as effective. The evidence for unconditional cash transfers is also unconvincing (Ruel & Alderman, 2013). For example, evaluations of the Ethiopian Productive Safety Net Program have repeatedly found no discernible impacts on growth or risk for wasting among children in targeted households. Cash transfers, conditional and unconditional, have a slightly more positive effect on girls’ nutrition than that of boys (Manley et al., 2012).

There have been relatively few evaluations of the impact of food transfers on nutrition outcomes. A recent set of studies comparing food with cash transfers found variation in effect in different countries (Hoddinott et al., 2013). Very generally, food transfers had more of an impact on energy intake whereas cash transfers had more of an impact on dietary diversity. Whilst this effect has been seen in other studies, it is not consistent in all settings and has generally not been related to subsequent changes in growth or risk of wasting.

Recent reviews have shown that school feeding is not an effective way of improving nutrition outcomes, primarily because it fails to target children during the first 1000 days of their development (Alderman & Bundy, 2012). This is widely viewed as the critical window of opportunity for preventing malnutrition. There is emerging evidence that school feeding can have a positive impact on the nutrition of younger siblings. Whether this represents the most cost-effective way of achieving this outcome is debatable. Schools might provide a useful platform for promoting nutrition messages and for reaching adolescent girls (Bhutta et al., 2013). However, the benefits and risks of school-based nutrition programmes have not been tested.

Key texts

Manley, J., Gitter, S. & Slavchevska, V. (2012). How Effective are Cash Transfer Programmes at Improving Nutritional Status? A Rapid Evidence Assessment of Programmes’ Effects on Anthropometric Outcomes. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
Are conditional cash transfer programmes more successful than unconditional programmes at improving child health? This systematic assessment finds programmes diverge greatly in their effectiveness. Higher marginal effects are found in the most disadvantaged areas, and in countries with poorer health care systems. Girls benefit more than boys in height for age measures. Conditionalities linked to requiring work or savings behaviour adversely affect programme success.
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Ruel, M. T. & Alderman, H. (2013). Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536-551.
This article is one in a series of four papers evaluating maternal and child nutrition, overweight and obesity in women and children, and their consequences in low- and middle-income countries. This paper reviews evidence of nutritional effects of programmes in four sectors—agriculture, social safety nets (SSN), early child development, and schooling. On social safety nets, the evidence base is quite robust in some areas, and shows that SSN have had weak impacts on child nutrition. This is potentially because of weaknesses in nutrition goals and actions, and poor service quality.
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Hoddinott, J., Gilligan, D., Hidrobo, M., Margolies, A., Roy, S., Sandström, S., Schwab, B. & Upton, J. (2013). Enhancing WFP’s Capacity and Experience to Design, Implement, Monitor, and Evaluate Vouchers and Cash Transfer Programmes: Study Summary. Washington, DC: IFPRI.
The International Food Policy Research Institute (IFPRI) evaluated four pilot projects to assess the comparative performance of cash transfers, food payments, and vouchers on household food security. The studies in Ecuador, Uganda, Niger, and Yemen were carried out over the period 2010–2012. In all countries, an experimental design was used with modalities (cash, food, vouchers) randomly assigned at a locality level, and each area had well-functioning grain markets. The research found that effectiveness depends heavily on context, including beneficiary preferences, quantity and quality of diet. CTs are always cheaper to deliver than food. There is little to no evidence that beneficiaries sell food transfers or use cash for undesirable purposes.
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Alderman, H. & Bundy, D. (2012). School Feeding Programs and Development: Are We Framing the Question Correctly? The World Bank Research Observer, 27(2), 204-221.
How effective are school feeding programmes? The authors examine recent evidence and argue that school feeding is best viewed as an income transfer, with the strongest effects on reducing poverty and improving education and health. It is less useful to view school feeding as having direct impacts on nutrient deficiencies, enhancing learning or school attendance. It is not the best intervention for improving nutrition in children.
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Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., …, Maternal and Child Nutrition Study Group. (2013). Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet, 382(9890), 452-477.
This comprehensive literature review examines the evidence on what works for improving maternal and child nutrition. The paper identifies ten interventions which are likely to reduce child deaths by 15 per cent globally. It suggests that community delivery mechanisms may offer the best opportunities to reach underserved populations.
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Graduation

Graduation refers to the ability of individuals or households to exit a social protection programme by passing an eligibility threshold. In some cases the term is also used to mean graduating out of poverty. Not all social protection programmes aim to graduate beneficiaries (e.g. pensions), and some households lack graduation potential (e.g. those with chronically sick members) (Garcia & Moore, 2012: 129). Graduation can be time-bound; income-sensitive; or self-selecting. Graduation can also refer to countries graduating from aid. Countries may seek to graduate from externally funded programmes to sustainable national programmes (Bundy et al., 2009).

Some draw a distinction between ‘threshold’ and ‘sustainable’ graduation for individuals or households, where the former constitutes passing an arbitrary threshold required to leave a programme, and the latter is a transformative transition out of poverty (Sabates-Wheeler & Devereux, 2011). The BRAC model follows the latter approach by targeting the extreme poor and helping them onto a path towards sustainable livelihoods (Hashemi & Umaira, 2011). Social protection alone is unlikely to graduate individuals or households out of poverty, but it can protect them against drivers of poverty such as distress sales of assets (Slater et al., 2014). The value of transfers is generally too low to lift the extreme poor out of poverty, constituting on average only 23 per cent of the household’s income (Gentilini et al., 2014).

Key texts

Sabates-Wheeler, R. & Devereux, S. (2011). Transforming Livelihoods for Resilient Futures: How to Facilitate Graduation in Social Protection (FAC Working Paper 23). Brighton: Future Agricultures Consortium.
It is frequently claimed that the most innovative feature of social protection is that it has the potential to reduce the vulnerability of poor people to the extent that they can manage moderate risk without external support. This has led to an expansion of large-scale ‘productive safety net’ programmes. This paper maps out the theory of change underpinning graduation (threshold and sustainable graduation) and sets out the range of enabling and constraining factors that facilitate or undermine this process. The authors state that they are aware only of social protection programmes which reach threshold graduation. It is assumed that some programmes achieve sustainable graduation, but this has not been empirically tested.
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Hashemi, S.M. & Umaira, W. (2011). New Pathways for the Poorest: The graduation model from BRAC (CSP Research Report 10). Brighton: IDS.
BRAC has developed an extremely successful ‘graduation model’ in the Challenging the Frontiers of Poverty Reduction – Targeting the Ultra Poor (CFPR-TUP) programme. It combines support for immediate consumption with an asset grant to start an economic activity and provides skills training, basic health care assistance and access to financial services. Participants graduate when they pass the threshold from ‘extreme’ to ‘moderate’ poverty, and are encouraged to access BRAC’s standard microfinance programme. This report provides quantitative and qualitative evidence on the success of the model. Most households moved away from day labour towards self-employment and small businesses. Much of the success rests on the confidence, empowerment, social networks and skill of the participant women. Structural barriers remain, and the model acknowledges that not everyone can graduate from extreme poverty through market-based economic livelihoods strategies.
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Empowerment

There is a major debate about whether and how social protection can empower poor, vulnerable or socially excluded people, but the evidence base is slim on this objective. Much of the literature on empowerment looks at women.

Most social protection programmes do not have the specific goal of women’s empowerment, but many programmes have had intended and unintended effects on women (Holmes & Jones, 2010). These include: enhanced knowledge and skills; increased economic activity, credit and social capital; increased or decreased marital tensions (Holmes & Jones, 2010). Overall, women’s decision-making power in the household and the community does not appear to increase as a result of social protection programmes (Holmes & Jones, 2010). The evidence on CCTs only weakly supports women’s empowerment impacts (Molyneux, 2008).

A systematic review on the impacts of health insurance revealed that there is very little evidence on health insurance and community empowerment, seen as involvement of the community in the organisation of health services (Spaan et al., 2012). Partially this is because of the difficulties of measuring this kind of impact.

Key texts

Holmes, R. & Jones, N. (2010). Rethinking Social Protection Using a Gender Lens (Working Paper 320). London: ODI.
To what extent is social protection programming reinforcing women’s traditional roles and responsibilities, or helping to transform gender relations in economic and social spheres? This paper synthesises multi-country research, finding that the integration of gender into social protection approaches has so far been uneven at best. Broader policy commitment to gender equality and women’s empowerment is not often reflected in social protection objectives. Overall, a comprehensive approach to tackling gender-specific vulnerabilities has been limited. However, all the programmes studied had both intended and unintended effects on women and gender relations. Attention to dynamics within the household can help to maximise positive programme impacts and reduce potentially negative ones.
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Molyneux, M. (2008). Conditional Cash Transfers: A Pathway to Women’s Empowerment? (Pathways of Women’s Empowerment Working Paper 5). Brighton: IDS.
Are CCTs really providing long-term empowerment to women? This review of CCTs, particularly of PROGRESA in Mexico, argues that, although these programmes are widely replicated due to their perceived positive impact in reducing poverty, they reinforce asymmetric gender roles. PROGRESA aims to empower women, and women involved in the programmes report that, in general, they experience greater self-esteem, well-being and autonomy. However, the programme’s gender bias reinforces the position of women as mothers, tying them more closely to the home.
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Spaan, E., Mathijssen, J., Tromp, N., McBain, F., Have, A.T. & Baltussen, R. (2012). The impact of health insurance in Africa and Asia: a systematic review. Bulletin of the World Health Organization, 90(9), 685-692.
Some 159 studies from Africa and Asia were included. The paper reviews impacts on: financial protection, utilisation, social inclusion, resource mobilisation, quality of care and community empowerment. Strong evidence shows that community-based health insurance (CBHI) and social health insurance (SHI) improve service utilisation and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilisation too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive.
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Social exclusion

The main arguments for why social protection can reduce social exclusion are: a guaranteed minimum income can give greater independence, control, self-esteem, and the ability to contribute to community life (Babajanian et al., 2014). This is in addition to the expected benefits of greater investment in human capital and livelihoods support. At the macro level, making social protection a legal right can address drivers of social exclusion, and reduce the access costs of services and utilities (Babajanian et al., 2014).

There are few studies analysing the relationship between social protection and social exclusion, and therefore little evidence to draw on to establish causal pathways and possible outcomes. There is a very small evidence base which suggests that social protection programmes have some impact on inclusion, including social participation and social networks, but that interventions have not delivered transformative changes (Babajanian et al., 2014). There is also some evidence that interventions can address the drivers of social exclusion (Babajanian et al., 2014).

There is weak evidence that health insurance has a positive impact on social inclusion, measured through enrolment and utilisation patterns of vulnerable groups (Spaan et al., 2012). Health insurance can reach vulnerable groups by making enrolment free or discounted – cost is the main barrier cited by these groups (Spaan et al., 2012).

In many countries, social insurance and labour market programmes only benefit those in formal employment (World Bank, 2011). Informal and agricultural workers, and those who cannot work are often excluded (World Bank, 2011). The socially excluded are often also the hardest to reach, making it particularly difficult and expensive to include them (World Bank, 2011). Programmers may have to make a trade-off between coverage and cost-effectiveness (World Bank, 2011).

Key texts

Babajanian, B., Hagen-Zanker, J. & Holmes, R. (2014). How do social protection and labour programmes contribute to social inclusion? Evidence from Afghanistan, Bangladesh, India and Nepal. London: ODI.
This paper draws on the findings from four country case studies: life skills education and livelihoods training for young women in Afghanistan; asset transfers in the Char river islands and a food transfer programme in Bangladesh; a health insurance programme in India; and the Child Grant cash transfer in Nepal. All interventions contributed to wellbeing outcomes. All interventions contributed to strengthening social relations, including social participation and social networks. However, the findings also show that, on many occasions, the interventions have not delivered transformative changes in the lives and livelihoods of excluded households and individuals.
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Economic growth

The primary aim of social protection is usually to reduce poverty rather than to promote macro-level growth. There is more evidence on the impacts of social protection on local economic growth than macroeconomic growth. There is limited evidence of the effects of transfers, both in addressing inequality through redistributing resources, and in creating economic growth (Alderman & Yemtsov, 2014). All the evidence suggests only limited impacts on growth.

Social protection is commonly understood to help increase human capital, and therefore to enhance households’ productivity in the long-term, as well as potentially to increase livelihood opportunities in the short term (Slater et al., 2014). There is strong evidence that CCTs could lead to increased household consumption and investment in education (Kabeer et al., 2012). Evidence suggests that transfers not only reduce immediate poverty but can also allow investments in assets for the future, contributing to inclusive growth (Alderman & Yemtsov, 2014). But the evidence on this is patchy.

Social protection can also help stimulate a local economy through the injection of cash, can create community assets, and improve local labour markets, for example by public works programmes increasing the demand for labour (Slater et al., 2014). Again, there is only patchy evidence for this. There is limited evidence that CCTs have spill-over effects on the local economy, though no evidence that they lead to local inflation (Kabeer et al., 2012).

Key texts

Alderman, H. & Yemtsov, R. (2014). How can safety nets contribute to economic growth? The World Bank Economic Review28(1), 1-20.
How do social safety nets contribute to growth? There are four pathways: i) enabling households to make better investments in their future and changing incentives for investment in human capital; ii) managing risk; iii) creating assets and household-level investments; iv) safety nets can relax political constraints on policy. Growth alone is not a justification for implementing safety nets; this argument is secondary to poverty reduction and equity.
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Slater, R., McCord, A. & Mathers, N. (2014). Guidance note for DFID: Exploiting the synergies between social protection and economic development. London: ODI.
This note is intended to help DFID staff and others working on social protection to understand how to maximise synergies between social protection and economic development. It goes step-by-step through the knowledge, analysis, decisions and practical steps required to do this. It focuses on low-income countries, and local and community level growth. The guidance follows the cycle of designing and implementing a social protection programme and provides advice about what to do during each stage.
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Kabeer, N., Piza, C. & Taylor, L. (2012). What are the economic impacts of conditional cash transfer programmes? A systematic review of the evidence (Technical report). London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
This systematic review examines 46 papers with evidence on the economic effects of CCTs. It concludes that: the evidence is strong that CCTs could lead to a rise in overall household consumption, increase investment in productive assets, reduce child labour and increase school attendance. The evidence is mixed as to the impacts on adult labour, with increases in market work by both men and women in some contexts and increases in leisure and domestic work in others. There is persuasive evidence that CCTs protect household consumption and educational patterns during times of crisis. There is limited evidence that CCTs have spill-over effects within communities in terms of poverty reduction, increased loans and transfers and household behaviour. There is no evidence that CCTs lead to inflationary pressure in the local economy.
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