Abstract Background Cash transfers are an increasingly common intervention in the Syrian refugee response to meet basic needs, though there is little known of their potential secondary impact on health outcomes in humanitarian settings. Methods A quasi-experimental prospective cohort study was implemented from October 2018 through January 2020 to assess the effectiveness of multi-purpose cash (MPC), community health volunteer (CHV)-led education, combined with conditional cash transfers (CCT) with respect to health measures among Syrian refugees with type II diabetes in Jordan. Results CHV + CCT participants had the highest expenditures at endline and were the only group with statistically significant increases in payments for outpatient diabetes care (25.3%, P < 0.001) and monthly medication costs (13.6%, P < 0.001). Conversely, monthly spending on diabetes medication decreased significantly in the CHV only group (− 18.7%, P = 0.001) yet increased in the MPC and CHV + CCT groups. Expenditures on glucose monitoring increased in all groups but significantly more in the CHV + CCT group (39.2%, P < 0.001). The proportion of participants reporting regular diabetes care visits increased significantly only in the CHV + CCT group (15.1%, P = 0.002). Specialist visits also increased among CHV + CCT participants (16.8%, P = 0.001), but decreased in CHV only participants (− 27.8%, P < 0.001). Decreases in cost-motivated provider selection (− 22.8%, P < 0.001) and not receiving all needed care because of cost (− 26.2%, P < 0.001) were significant only in the CHV + CCT group. A small significant decrease in BMI was observed in the CHV + CCT group (− 1.0, P = 0.005). Decreases in HbA1C were significant in all groups with magnitudes ranging from − 0.2 to − 0.7%. The proportion of CHV + CCT participants with normal blood pressure increased significantly from baseline to endline by 11.3% ( P = 0.007). Conclusions Combined conditional cash and health education were effective in improving expenditures, health service utilization, medication adherence, blood pressure, and diabetes control. The lower cost health education intervention was similarly effective in improving diabetes control, whereas unconditional cash transfers alone were least effective. Study findings suggest that conditional cash or combined cash and health education are promising strategies to support diabetes control among refugees and that where the purpose of MPC is to improve health outcomes, this alone is insufficient to achieve improvements in the health of refugees with diabetes.
Abstract Background Cash-based assistance in humanitarian contexts has grown substantially in recent years, yet little is empirically known about differential impacts of cash for diverse beneficiaries, which could better inform assistance targeting. In the context of increasing food insecurity and extreme levels of famine in South Sudan despite significant scale-up of humanitarian assistance, this analysis examined food security and household economy outcomes to better understand the impact of cash assistance and characteristics associated with worsened household food security and coping strategies. Methods In 2019–2021, a prospective cohort study was conducted leveraging a program providing cash for work in community gardens. 1213 households receiving cash prior to the start of the study (Cohort A/B), 582 non-intervention households (Control), and 300 households that received cash after the start of the study (Cohort C) completed 2 interviews spaced one year apart to measure household food insecurity and coping mechanism adoption. Results There were no significant differences in change over time in household hunger score ( p = 0.074), livelihoods coping strategy index score ( p = 0.104), or meal frequency ( p = 0.113) between program participants and the comparison group. The comparison group had a significantly larger increase in dietary diversity over time (0.6 vs. 0.2 in Cohort A/B, p = 0.005); however, at endline there were no significant differences in dietary diversity between program participants and the non-intervention group (4.3 in both groups). There were few factors associated with increased likelihood of worsened food security and coping outcomes, the most noticeable being recent investment livestock, which was associated with 1.5 times greater odds of worsened hunger and 1.63 times greater odds of worsened coping strategy adoption. Conclusion Cash transfers did not appear to have lasting benefits on food security and livelihoods coping strategy use. Larger transfer sizes may need to be considered in future programming to achieve more substantial improvements in household food security; however, maintaining rather than improving household food security may be sufficient in worsening food crises contexts.
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