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

04 Dec 2019
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“Why not cash?” is now a common question in the humanitarian space.1 As the share of cash and vouchers in total humanitarian aid continues to grow – reaching US$4.7bn in 2018 out of a total spend of US$28bn – humanitarian agencies increasingly begin their interventions with this question. The shift to cash and voucher assistance (CVA) is happening because it promises benefits compared to in-kind aid. These range from cheaper and more efficient delivery mechanisms to greater dignity and choice. Above all, the expectation is that cash will drive more effective humanitarian action.

But how do people affected by crisis themselves view cash-based aid and its scale-up? Ground Truth Solutions has set out to find out through regular surveys, user interviews, and community engagement sessions between humanitarian actors and CVA recipients. The goal of these activities, which are part of Ground Truth’s Cash Barometer initiative, is to learn from the experience of recipients to maximise the benefits of cash assistance by ensuring that it is truly people centred.2

What we have learned

Cash has become an increasingly central topic in our surveys of people affected by crisis over recent years and this brief summarises what we have learned from conversations with some 20,000 aid recipients in 11 countries.3

Overall, people affected by crisis tend to prefer cash over other types of aid. They consider it better at helping them meet their needs and become self-reliant. Larger transfer amounts correspond with more positive perceptions. While there is no consensus on what constitutes the best transfer mechanism, respondents generally prefer payment systems that offer flexibility in how they receive and spend the cash.

But too often the potential of CVA is not realised, especially for the most vulnerable. Unless the focus is on better rather than more CVA, cash programmes will not maximise their promise of choice, dignity and value. In this brief we look at what better CVA looks like to recipients.

A preference for cash

Many humanitarian practitioners consider CVA one of the best ways to help people in crisis.4 Respondents to surveys across seven countries in 2017 and 2018 agree, preferring cash or a mixture of cash and in-kind aid to only in-kind assistance.5

This reflects the fact that cash is a universal medium of exchange and most people, regardless of vulnerability, find it an effective way to meet their needs. This is also the case in places where markets are volatile and access to them more restricted. Take Afghanistan, Lebanon, Somalia and Uganda, where our findings indicate that people prefer cash over other forms of aid. Overall, cash recipients are generally more positive about the extent to which their needs are met than those receiving only in-kind aid.6 Cash recipients are also more likely to say that aid helps them to become self-sufficient compared with people who do not receive cash.7

Cash is an unmet need

The humanitarian community is organised around technical sectors and agency mandates, and the prevailing view is that cash is a way to meet needs rather than a need in itself. For aid recipients, the distinction between modality and need may seem theoretical, even irrelevant. We draw this conclusion because when we ask people about their unmet needs, cash is the most common answer.

Needs 2

Cash on its own, however, is not enough. Some 75% of cash recipients ask for something other than simply to receive more cash. They often say they also want food, shelter and health care.

The more cash, the better

Unsurprisingly, the higher the transfer the greater the satisfaction. Data from Afghanistan in 2017 and Lebanon in 2018 shows that people’s satisfaction with CVA goes up as transfer amounts increase.8 Larger transfer amounts also correlate with better outcomes. According to studies by Give Directly, larger sums enable families to make long term investments in durable solutions and income generating activities. This results in more revenue for the family, as well as improvements in their food security and psychological well-being.9,10

The more flexible, the better

Advocates for CVA argue that an important attribute of cash is that it promotes choice. Our findings substantiate this claim, with respondents expressing a preference for flexibility – an indicator of choice – in several locations. Take Lebanon, where some 76% of cash recipients (n=236) preferred cash over vouchers. In Turkey, 72% (n=101) preferred cash in hand, while only 10% preferred vouchers. Qualitative work in Kenya, Iraq, Cameroon and the DRC also highlighted recipients’ preference for flexible mechanisms that allow them to withdraw, save and spend cash as they see fit. Below are the more detailed survey findings for Kenya and Iraq.

Comparative Importance N value Cropped

When people don’t have this choice, they resort to turning in-kind aid into cash. In Cox’s Bazaar, where we asked Rohingya refugees (n=1048) whether people in their community sold aid items to meet their cash needs, 57% of respondents said yes – 62% of the men surveyed, and 53% of the women. Follow-up questions indicated that food is the item they sell most (63% of respondents selected “food” from a multiple-choice list). The most common items people purchased with the cash were meat and fish, spices, medicine and clothing. This suggests that food remains a top priority, but families’ needs vary.

What money cannot buy

A strong argument in favour of CVA is that it allows choice and promotes agency, and that this in turn promotes the dignity of aid recipients. While this is supported by the data, our research shows that cash alone does not enhance dignity. Poor communication is one factor that can undermine its positive impact if recipients are unsure about why they are eligible for cash or do not know how long transfers will continue. Our surveys with cash recipients in Kenya and Iraq illustrate this point.

Eligibility Kenya Iraq

Lack of information is not, of course, a challenge specific to cash programmes. Indeed, cash recipients are more likely to say they feel informed about aid than those who do not receive CVA. This is true in all countries we surveyed except Iraq. The explanation may be that cash tends to go to people who understand the aid system better, or that cash providers are better at explaining what they have to offer than those purveying other types of aid.11

How to maximise the benefits of cash assistance

CVA champions have amassed an impressive amount of evidence that has helped sway humanitarian decision-makers. An example is the European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG ECHO), that over a ten-year period made a striking shift from capping the permissible ratio of cash-based aid to using cash as the default modality. Or consider how widespread market analyses have become in humanitarian responses. Our interviews show that people support the change in direction. But their feedback also demonstrates that simply replacing one aid modality with another or providing CVA alongside other assistance is insufficient. Amidst ambitious promises that cash will deliver dignity, choice, and value, the way cash programmes are implemented is key. Cash can undermine dignity just as much as other forms of aid absent good communication and trust between providers and receivers.

To maximise the benefits of CVA, more needs to be done to consult intended recipients so that programmes reflect their priorities. Implementers should re-examine how they communicate cash programmes to recipients to see how they could do better. More broadly, it is time to ensure potential recipients’ views are considered in determining what delivery mechanisms to use. At a minimum, they should receive support in using payment systems that are unfamiliar. They should also have more say in what they can spend it on. Where there are market or security constraints, agencies can always review and revise the approach later, but they should do so based on feedback and dialogue.

Hotlines and post-distribution monitoring are important, but they are not a panacea. What’s needed is more frequent and direct engagement during all phases of the CVA cycle, particularly when designing new programmes, identifying payment systems, targeting recipients, and project evaluation. Prioritising community engagement will enhance the dignity and empowerment that lie at the heart of the CVA promise


[1] For more details, see and
[2] Mirroring findings from Wilson and Krystali (2017).
[3] Afghanistan, Bangladesh, Iraq, Haiti, Lebanon, Uganda, and Somalia.
[4] Although there are many examples of humanitarian practitioners advocating for CVA, the DFID-commissioned High Level Panel on Humanitarian Cash Transfers (2015) produced seminal reports and background notes documenting this evidence. See Bailey and Harvey, “State of evidence on humanitarian cash transfers” (ODI, March 2015); Bailey and Harvey, “Cash transfer programming and the humanitarian system” (ODI, March 2015); ODI and the Center for Global Development, “Doing cash differently: how cash transfers can transform humanitarian aid" (ODI/CGD, 2015).
[5] See UN, “Common Donor Approach for Humanitarian Cash Programming” (New York: Relief Web, 2019).
[6] When asked if their needs are met, cash recipients responded an average of 0.16 points higher on a five-point Likert scale compared with those receiving only in-kind aid.
[7] Cash recipients responded on average 0.11 points higher on the Likert scale than non-cash recipients on questions related to whether the aid they receive enables them to be more self-sufficient.
[8] In Afghanistan (2017), people’s satisfaction with CVA increased by an average of 0.5 on a five-point Likert scale for every 10,000 Afghanis ($130) they received. In Lebanon in 2018, satisfaction increased by 0.1 for every million Lebanese Pounds ($660). It is important to note that in Lebanon has a high cost of living (according to WFP in 2018, the survival minimum expenditure basket is calculated at $435 for a family of 5 people, monthly) and organisations provide comparatively low transfer values of cash assistance ($175 per household monthly). This likely influences the findings that receiving a lot more cash corresponds to increased satisfaction.
[9] See Michael Faye and Paul Niehaus, “A/B Testing Foreign Aid,” The Atlantic, 14 Sept 2018.
[10] 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.
[11] 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