Impacts of an Unconditional Cash Transfer on Household Food and Nutrition Security and Child Health Outcomes in Malawi

Social cash transfer programs are increasingly employed in sub-Saharan Africa to reduce household vulnerability to extreme poverty, strengthen food and nutrition security, and improve child health. Many of these programs are government-run, and as countries take these programs to scale it is important to understand the range of impacts programs can have as well as how these impacts occur. The main objectives of this dissertation are to determine if the Government of Malawi’s Social Cash Transfer Program (SCTP) improves household food and nutrition security (FNS) and young child health, and to understand the mechanisms through which the program achieves these impacts by analyzing critical relationships along the causal chain. This study uses baseline and 17-month follow-up household panel data from a large-scale evaluation of the SCTP. The evaluation is a cluster-randomized control trial that employs both random selection and random assignment to treatment and delayed-entry control groups. The first paper uses the difference-in-differences approach and specifies Generalized Linear Models to estimate average treatment effects of the program on three components of FNS: current economic vulnerability, diet quantity, and diet quality. Results show protective program impacts during the lean season on diet quantity, but beneficiary households experience little improvement in diet quality or current economic vulnerability to food insecurity relative to controls. The second paper applies the health production function framework to trace the impact of the SCTP through household demand for child health inputs to child health outcomes. The empirical strategy combines the difference-in-differences approach with instrumental variables to estimate the derived health input demands and the effects of these inputs on important child health outcomes. We also estimate a fixed-effects specification of the health production function as a robustness check for potential weak instruments. Study results indicate that after approximately one year of exposure the program has strong positive impacts on food expenditures and apparent caloric availability, but not child feeding, and that these impacts do not translate to significant improvements in child health outcomes. Clear policy and program implications emerge related to the purchasing power of the cash transfer and the importance of integrated social protection initiatives.Doctor of Philosoph