1. Cash or Food: What is best for Karamoja? Adapted from: Gilligan et al. (2013) “Impact Evaluation of Cash and Food Transfers at Early Childhood Development Centres in Karamoja”. Final Impact Report. IFPRI: Washington DC. Nassul Kabunga, PhD Presentation and Discussion of UPW Policy Briefs Uganda Evaluation Week, Silver Springs Hotel, Kampala, Uganda, June 13-17, 2016 Office of the Prime Minister (OPM), Government of Uganda

2. Research Question Social protection programmes that provide periodic FOOD rations or CASH handouts are common in many parts of the world Organisations e.g. WFP have traditionally delivered FOOD rations to poor households in periods of temporary food shocks In other cases, CASH handouts are a popular alternative, particularly for large-scale social protection programmes BUT, there is limited evidence on how best to design such aid programmes for effective implementation Particularly, it is UNCLEAR whether FOOD rations or CASH handouts are more cost effective and/or more beneficial to households in similar contexts

3. Research Question This study aimed at answering four (4) specific sets of questions: 1.Is it CASH or FOOD that is relatively more beneficial in improving household food and nutrition security? 2.Is it CASH or FOOD that will likely improve child enrolment and participation in school? 3.Is it CASH or FOOD that will improve a child’s mental and/or physical development? 4.Which delivery modality of aid is relatively cheaper in terms of operational costs: CASH or FOOD delivery?

4. Intervention In 2011/12, WFP decided to provide an incentive in form of a take-home FOOD ration or CASH handout to households with children enrolled at UNICEF-sponsored preschools All intervention sites (98 preschools targeted by WFP) were located in Karamoja sub-region, fairly distributed in the districts of Kaabong, Kotido and Napak Households that enrolled their children aged 3-5 years in preschools would, for every 6 weeks receive,  EITHER: a FOOD ration  corn-soy blend (CSB), Vit-A Oil, Sugar  OR: a CASH handout sufficient to buy the equivalent of the food ration in the market (i.e. UGX 25,500)  OR: NOTHING (no incentive at all)

5. Methods To answer the research questions, a social experiment— randomly assigning preschools to each intervention—was conducted  Prior to interventions in Sept’10, enrolment lists were collected from each preschool  Using these lists, ~25 households with enrolled children for each intervention were randomly sampled to participate in the research  Rich datasets were then collected using questionnaires  before (Sep-Oct 2010) and after the interventions (Mar-Apr 2012)  Data from ~2,400 households were collected in both rounds  Ensures that similar schools have an equal chance of receiving any of the 3 interventions

6. Methods Data collected aimed at assessing changes to households (over time) in several aspects;  e.g. household food availability, child food consumption patterns, and child participation in preschools, etc. Additionally, child body measurements (anthropometry) and blood tests were conducted to assess and compare children’s nutritional and health status Finally, a series of other interactive tests with children were conducted to assess and compare changes on children’s mental growth and capabilities

7. Findings   Relative to FOOD-recipient households and households that received NOTHING, CASH-recipient households substantially increased intake of food and non-food items  CASH-recipient households also improved diet quality and diversity for all members including for young children:  Increased amount of calorie intakes by 20%  Doubled intakes of rich foods e.g. milk, eggs, meat, poultry, fats, etc.  Children increased frequency of intake of animal sourced protein food e.g. meat, eggs, and milk by 66-100%  Cash was NEVER used for undesirable purposes, e.g. alcohol  Cash could be saved and spent at later times to ensure long- term food security

8. Findings  With respect to nutrition and health assessments, children in CASH-recipient households benefited more relative to FOOD-recipient households:  FOOD-recipient households DID NOT reduce child anaemia yet, CASH-recipient households reduced anaemia for children aged 4.5-6 years by 10%  CASH-recipient households reduced child wasting (average lower child weight) prevalence by 5% relative to the FOOD-recipients  FOOD rations were ONLY beneficial in reducing stunting (average lower height) prevalence by 9%, but for children <3 years Possible Implications?  CASH is somehow vital in protecting the nutritional status of children at the age when they join preschools  Nutritional FOOD rations also benefited younger children that do not attend preschools i.e. children < 3years

9. Findings  With respect to participation in preschools activities and children’s mental growth, CASH-recipient households performed better relative to the FOOD-recipient group:  Parents from CASH-recipient households followed-up more often on preschool activities, attended meetings and contributed to preschool infrastructure developments e.g. construction of shelter, toilet, etc.  Preschools associated with CASH-recipient households opened 2 more days/week, with children attending 7 more hours relative to FOOD-associated preschools  Children aged 3-5 years in CASH-recipient households scored relatively higher on several domains of mental development compared to the other groups  CASH improved visual reception, receptive and expressive language by 11%

10. Findings More than 60% of both FOOD and CASH beneficiaries preferred to buy unfortified posho rather than CSB if both are available in the market 90% of all participants believed that provision of a mix of some food and some cash would be more beneficial In terms of operational costs, CASH handouts were cheaper to deliver to beneficiaries than food rations:  All 7 FOOD deliveries to households (including the value of the ration) costed US $ 117.5 while CASH deliveries costed US $ 96.7. i.e. delivery of food rations costed US $2.9 more per delivery Possible Implications: CSB, the main component of the food ration, is not highly valued in the local context

11. Recommendations Since CASH handouts performed better than FOOD rations in many aspects CSB, the major component of the FOOD ration is not highly valued in the local context, but is evidently highly nutritious for young children.  Similar programmes should consider the provision of CASH instead of food rations to poor people living in similar contexts  Future programmes should deliver a share of CASH and FOOD (Cash-Food-Mix). possibly, the FOOD ration should contain CSB and a reasonable amount of locally produced maize meal