Health and Social Protection for Orphans and Vulnerable Children: Household Cash Transfers As Mitigators of Risk
In sub-Saharan Africa, cash transfers have been shown to improve outcomes for orphans and vulnerable children (OVC) in the context of HIV/AIDS. Household asset-holding can be a protective factor against economic shocks, but for OVC and the households which often care for them, a number of additional risks exist which asset-holding may or may not offset. The purposes of this study are twofold: (1) to examine how cash transfers (CT) or conditional cash transfers (CCT) significantly improve OVC social and health outcomes by moderating existing risk factors; and (2) to examine whether household asset-holding offsets OVC risk factors and/or attenuates the relationship between CT/CCT and OVC outcomes.
Methods
Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to each of three study arms – CT, CCT, or control. The sample included 5,331 children ages 6-17 from 1,697 households deemed the most vulnerable through a baseline census survey and community verification. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 80% school attendance). Models included child-level risk factors (age and orphan status); household risk factors (number of adults with chronic illnesses and disabilities, household size); and household asset-holding. Interactions of study arms by each risk and protective factor were systematically tested as a means of exploring mechanisms by which cash transfers impact outcomes.
Findings
Controlling for child-level risk and protective factors, high household asset-holding was associated with decreased likelihood of child’s chronic illness (p<.05) and increased birth registration (p<.001) and school attendance (p<.001), but household assets did not buffer risk factors. Orphan status (particularly maternal, double, and orphans with unknown parent status; p<.001) was associated with decreased likelihood for birth registration, while paternal (p<.001) and double-unknown orphans (p<.05) were less likely to attend school. In addition, CT moderated the risk of paternal orphan status on likelihood of birth registration (p<.05). CT/CCT did not moderate the effect of any other risk or protective factors on outcomes.
Conclusion and Implications
This study provides evidence that CT and CCT boost social protection for OVC. These effects remain when controlling for child-level risk factors, such as age and orphan status; household risk factors, such as adults with chronic illnesses and disabilities and household size; and household protective factors such as asset-holding. These mechanisms appear to be direct in that CT/CCT are not moderated by asset-holding, nor do these intervention arms moderate any pre-existing risk factors except that cash transfers offset risk for paternal orphans for one measure of social protection. Additionally, this study provides evidence that maternal and double orphans, and particularly orphans of unknown status who may be abandoned by parents, are less likely to obtain a birth registration. While improved health outcomes remained out of reach in this sample over a short time period, this study adds to the growing evidence of the effectiveness of cash transfer programs in the context of sub-Saharan Africa in achieving social outcomes.