Changing the perspective: what recipients think of cash and voucher assistance

04 Dec 2019
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In 2018, humanitarian cash and voucher assistance (CVA) totalled $4.7bn, and it continues to grow as humanitarian agencies increasingly begin their interventions with the question “Why not cash?”1 Cash assistance promises a range of benefits, from cheaper and more efficient delivery mechanisms than in-kind aid, to promoting dignity and choice for aid recipients.

Expectations are high that cash will allow for more effective humanitarian action. But how do people affected by crisis view cash-based aid and its recent scale-up? Ground Truth Solutions aims to find out through our Cash Barometer project, which we are rolling out in two new countries. The goal is to use cash recipients’ perceptions and experiences to maximise the benefits of cash assistance and to ensure that aid is truly people-centred.2

As a first step, we analysed feedback from over 20,000 aid recipients in 11 countries, as summarised in the Humanitarian Voice Index database. Over the past three years, cash has become a more central topic in our interviews with affected people and has featured prominently in Ground Truth Solutions surveys in Lebanon, Haiti, Afghanistan, Somalia, Uganda, Iraq, and Bangladesh, as well as projects in Kenya, Cameroon, and the Democratic Republic of the Congo.3

We find that people affected by crisis prefer cash over other types of aid, and that cash helps them to meet their own needs and increases their sense of self-reliance. Larger transfer amounts correspond with more positive responses. While there is no consensus on how to best receive transfers, people prefer payment systems that offer choice and flexibility.

Advocates for (more) cash and voucher assistance will be pleased to read that affected people largely agree with them on the potential benefits of CVA. But too often, for the most vulnerable, this potential does not translate into reality. Unless donors and implementers shift their mindset from “more CVA” to “better CVA,” cash programmes will not offer the maximum benefits of dignity, choice, and value that affected people deserve.

Cash is better

Many humanitarian practitioners consider CVA one of the best ways help people in crisis. Affected people surveyed across seven countries in 2017 and 2018 agree. In Bangladesh, for example, we found that people preferred cash or a mixture of cash and in-kind aid.4

In most contexts, people are used to meeting their needs with cash well before they receive any humanitarian support. So when they experience first-hand the humanitarian system’s inability to provide everything they need, it is understandable that they want to take matters back into their own hands. Cash has the potential to enable this, and it also seems more effective at meeting needs. In Afghanistan, Lebanon, Uganda, and Somalia, we found that cash recipients are more likely to say that aid meets their needs, averaging 0.16 points higher on a five-point Likert scale satisfaction rating compared to people who received other forms of aid. Importantly, cash recipients are also more likely to say that aid helps them to become self-sufficient, with an average increase of 0.11 on the Likert scale.

Cash is also the unmet need people mention most often. Since the humanitarian community is organised around technical sectors and agency mandates, the consensus is that cash is not a need, but a modality. For people who receive aid, this distinction seems theoretical at best, if not entirely irrelevant. When we ask those who say their needs are currently unmet about what they need, cash is the most common response. The other most commonly mentioned unmet needs are food and shelter.5

Needs 2

But cash alone is not enough. If we consider the responses from cash recipients alone, we see that 75% of those who say aid does not cover their most important needs ask for something other than (more) cash.

The more cash, the better

Unsurprisingly, larger transfers led to higher satisfaction according to our surveys. In Afghanistan in 2017 and Lebanon in 2018, average responses on a Likert scale to questions about cash satisfaction increased by 0.5 per 10,000 Afghanis (around $130 USD) and 0.1 per million Lebanese pounds (around $660 USD).

This is in line with the findings of other studies: large transfers generally correlated with better outcomes, particularly in terms of investments in durable solutions and businesses, food security, and psychological well-being.6,7

The more flexible, the better

A core driver of CVA advocacy is that cash promotes choice for recipients of aid. This is not merely an ideal, but is also reflected in our findings. A preference for flexibility, which is a clear indicator of choice, is apparent across several contexts. In Lebanon, 76% of cash recipients surveyed (n=236) preferred to receive cash over vouchers. In Turkey, 72% (n=101) preferred cash in hand, while only 10% preferred vouchers. Our qualitative work in Kenya, Iraq, Cameroon, and the DRC also highlighted the fact that users preferred cash transfers delivered through flexible mechanisms that allow them to withdraw and spend the money as they see fit. Survey responses in Kenya and Iraq showed that cash recipients cared most about their freedom to decide how to spend the transfer.

Comparative Importance N value Cropped

Where this preference for choice is not met, people seek the power to choose through other means. In Bangladesh, we asked 1,048 Rohingya refugees whether people in their community sell aid items to meet their cash needs, and 57% of respondents said yes, with men more likely than women to answer yes (62% of men, 53% of women). Follow-up questions indicated that people usually spent cash on food (meat, fish, and spices), medicine, and clothing. The most valuable item to sell was food (63% of respondents selected “food” from a multiple-choice list).

What money cannot buy

Those who promote CVA tend to argue that the choice inherent in (unrestricted) cash promotes dignity for recipients of aid. While this appears to be confirmed in many cases, our research shows that cash in and of itself does not enhance dignity. Communication is a major stumbling block here, with recipients often reporting confusion around cash-based assistance – they are unsure why they receive it or how long it will continue. The graph below presents our findings from Kenya and Iraq, where there was an obvious lack of awareness about the basic elements of cash programmes.

Eligibility Kenya Iraq

The challenge of communication is not limited to CVA. In fact, we see that cash recipients are more likely to say that they feel informed about aid than those who do not receive CVA. Their average response is 0.2 points higher on a five-point scale than non-cash recipients, which is a small but statistically significant effect across all the countries we surveyed, except Iraq. This could mean that cash tends to go to people who understand the aid system better, or that cash providers are comparatively better at explaining the assistance on offer.8

How to maximise the benefits of cash assistance

To convince sceptics, CVA champions have amassed an impressive evidence base. Its impact on the mindsets of key humanitarian decision-makers cannot be overstated. Take DG ECHO as an example: their U-turn from capping the permissible ratio of cash-based aid less than ten years ago to cash as the default modality today is striking. Or consider how widespread market analyses have become in humanitarian responses. Our interviews show that affected people support this transition. But their feedback also demonstrates that simply replacing one aid modality with another or providing CVA alongside other assistance will not be enough. Amidst ambitious promises that CVA will deliver dignity, choice, and value for affected people, implementation remains the key. When handled poorly, cash can undermine dignity just as much as any other form of aid.

To maximise the benefits of CVA, more needs to be done to consult affected people about the decisions that impact them, so that CVA design reflects their priorities. Implementers should re-examine how they communicate cash programmes to intended recipients to see what is not working and what could be improved. Beyond information sharing, developing CVA around the recipients’ perspectives could mean using familiar delivery mechanisms (or helping people learn how to use new payment systems) as well as offering maximum choice in terms of how to receive and spend the money. Where market or security constraints make this impossible, programmes should be reviewed and revised at a later stage, again based on feedback from and ongoing dialogue with affected people.

More consistent personal contact with recipients is also necessary, whether through money agents, third parties, community volunteers, or aid providers themselves. Existing activities and mechanisms, such as hotlines and post-distribution monitoring, can be better used to that end. Investments in more and better engagement with affected people during targeting, training, and project completion phases will cost money, which leaves less cash for people in need. Nevertheless, these investments will provide a much greater return in terms of dignity and empowerment, which are the most important promises of CVA.

What next?

With the support of the German Federal Foreign Office, we will use the Cash Barometer to facilitate an ongoing dialogue between humanitarian actors and affected people receiving CVA, beginning in Nigeria. This will be based on regular surveys, interviews, and facilitated community engagement sessions. We hope to encourage an honest discussion about how to make CVA more people-centred while maintaining best practices, such as technical quality and efficiency at scale – which is often a delicate balance. The findings will be discussed with key actors in country and published globally.

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[1] Development Initiatives, Factsheet: Key Trends in Global Humanitarian Assistance 2019 (Bristol: 2019), p. 7.
[2] See UN, “Common Donor Approach for Humanitarian Cash Programming” (New York: Relief Web, 2019).
[3] For more details, see groundtruthsolutions.org and humanitarianvoiceindex.org.
[4] Mirroring findings from Wilson and Krystali (2017).
[5] Afghanistan, Bangladesh, Iraq, Haiti, Lebanon, Uganda, and Somalia. While cash is recognised as an assistance modality (a way to meet needs, rather than a need itself), respondents cited cash as a need that could be met through aid.
[6] See Michael Faye and Paul Niehaus, “A/B Testing Foreign Aid,” The Atlantic, 14 Sept 2018.
[7] Johannes Haushoffer and Jeremy Shapiro, “The Short-term Impact of Unconditional Cash Transfers to the Poor: Experimental Evidence from Kenya,” The Quarterly Journal of Economics (2016): 1973–2042.
[8] See also Irina Mosel and Kerrie Holloway, Dignity and Humanitarian Action in Displacement (New York: Overseas Development Institute, 2019).


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Photo source: ICRC