The impact of the Lesotho Child Grant Programme in the lives of children and adults with disabilities: Disaggregated analysis of a community randomized controlled trial

Globally, people with disabilities are disproportionally affected by poverty. Social protection policies, including cash transfers, key strategies to address poverty “in all its forms”, but it is currently unclear how such programmes affect disabilities. This study examines differences in the impact of Lesotho Child Grant Programme (CGP) on food security, health, education and livelihoods between without using data from a community randomized control trial. Overall, this finds CGP had significant differential impacts for across multiple health indicators (e.g. increased expenditures, self-rated likelihood seeking healthcare). The also an decreasing number months households members faced extreme shortages. There was modest engagement paid work. only school enrolment children disabilities, however difference non-significant likely due underpowered sample sizes. receiving still experienced high levels absolute deprivation, were generally worse off compared indicating need adapted or complementary social other alleviation programmes. Partout dans le monde, la pauvreté touche de manière disproportionnée les personnes en situation handicap. Les politiques matière sociale, y compris transferts monétaires, s’avèrent cruciales pour lutter contre «dans toutes ses formes», mais ignore encore quelle mesure tels touchent Cette étude examine différences entre handicapées et non au niveau des répercussions du régime d’indemnités enfants sur sécurité alimentaire, santé, l’éducation revenus, base données issues d’un essai contrôlé randomisé mené une communauté. Dans l’ensemble, cette révèle que eu considérables différenciées handicap à l’aune nombreux indicateurs santé (tels l’augmentation dépenses soins l’amélioration autoévaluée, hausse probabilité recourir aux santé). Le également un diminuant nombre mois durant lesquels ménages avec sans membres ont souffert pénurie alimentaire aiguë. Un modeste bien différencié important par ailleurs été constaté participation travail rémunéré. n’a scolarisation handicapés, différence d’impact n’est pas significative est probablement liée échantillon insuffisant. En règle générale, bénéficiaires enregistraient toujours hauts niveaux privation absolue leur était globalement moins favorable celle handicapées, ce qui suggère nécessité d’adapter ou compléter sociale autres lutte pauvreté. A escala mundial, pobreza afecta las personas con discapacidad manera desproporcionada. Las políticas protección social, incluidas transferencias monetarias, son estrategias fundamentales para luchar contra “en todas sus formas”, pero no está claro aún cómo afectan estos programas discapacidad. el presente estudio se examinan diferencias repercusiones Programa Subsidios Infancia (Lesotho – CGP) tiene seguridad alimentaria, salud, educación los medios subsistencia sin discapacidad, partir datos procedentes ensayo comunitario controlado aleatorio. general, llega conclusión tuvo significativas diferentes función distintos indicadores salud (por ejemplo, incremento gastos autoevaluación del estado o probabilidad persona busque asistencia sanitaria). El también repercutió reduciendo número meses hogares miembros sufrieron escasez alimentos extrema. También observó impacto modesto, significativo distinto participación trabajo remunerado. solamente incidió tasa matriculación escolar caso niños discapacidad; embargo, diferencia fue significativa probablemente debiera al insuficiente tamaño muestras. beneficiaron siguieron padeciendo niveles extremos carencia teniendo menos recursos lo cual indica es necesaria una adaptada complementaria otros tipos reducción pobreza. Weltweit leben Menschen mit Behinderung überproportional häufig Armut. Sozialschutzstrategien wie Geldtransferleistungen gelten als wichtige Instrumente, um Armut ihren Formen zu bekämpfen, doch derzeit ist unklar, sich solche auf auswirken. Diese Studie untersucht die unterschiedlichen Auswirkungen Kindergeldprogramms von (Child Programme) Ernährungssicherheit, Gesundheit, Bildung und Lebensunterhalt ohne verwendet dabei Daten aus einer randomisierten kontrollierten Studie. Die Untersuchung kommt zum Schluss, dass das Kindergeldprogramm je nach Gesundheitsindikatoren (wie höhere Gesundheitsausgaben, selbst eingeschätzter Gesundheitszustand, Wahrscheinlichkeit Rückgriffs Gesundheitsdienstleistungen) signifikante differentielle für hatte. Das Programm wirkte auch insofern Ernährungssicherheit aus, Anzahl Monate gesenkt wurde, Haushalte Familienmitglieder vor extremer Nahrungsmittelknappheit standen. Zudem wurde eine geringere, aber dennoch Auswirkung Programms darauf ermittelt, ob bezahlter Arbeit sind. Auf den Schulbesuch nur bei Kindern außerdem war der Unterschied nicht signifikant wahrscheinlich durch kleine Stichproben bedingt. Insgesamt litten Kindergeldbezüger weiterhin stark unter absolutem Mangel, generell immer noch stärker übrigen Behinderung. Daher ein angepasster oder ergänzender Sozialschutz erforderlich, zusätzlich sollten weitere zur Armutsbekämpfung umgesetzt werden. Во всём мире лица с ограниченными возможностями несоразмерно страдают от бедности. Меры социальной защиты, в том числе денежные выплаты, являются одной из главных стратегией для преодоления бедности «во всех её проявлениях», хотя пока неизвестно, насколько они действительно помогают лицам возможностями. В исследовании на основе данных рандомизированного контрольного обследования местном уровне рассматривается, каким образом программа детских грантов (ПДГ) Лесото повлияла ситуацию продовольственной безопасностью, образованием и экономическим положением как здоровых людей, так тех, кто ограничен своих физических возможностях. целом, исследование показывает, что ПДГ оказала значительное дифференцированное влияние разные показатели здоровья лиц (такие увеличение расходов медицинское обслуживание, улучшение самочувствия, вероятность обращения за медицинской помощью). Программа отразилась ситуации сократив количество месяцев, течение которых обычные семьи инвалидами испытывали острую нехватку продуктов питания. Кроме того, она умеренное, значимо получение лицами работы по найму. Что касается занятий школе, помогла только здоровым детям при этом незначительно; причиной мог стать недостаточный размер выборок. возможностями, включённые программу, по-прежнему крайнюю нужду и, правило, пребывали худшем положении, чем здоровые люди, подтверждает необходимость адаптации или дополнения программ защиты других борьбы бедностью. 全球范围内, 残疾人不成比例地受贫困影响。包括现金转移支付在内的社会保护政策是应对“所有形式”贫困的关键战略, 但目前这类计划对残疾人的影响尚不清楚。本研究基于一项社区随机对照试验的数据, 分析了莱索托儿童补助计划(CGP)对残疾人和非残疾人在粮食安全、健康、教育和生计方面的不同影响。整体而言, 研究发现, 儿童补助计划对残疾人的多项健康指标(如增加的健康支出、自我评估的健康状况、寻求医疗保健的可能性)均产生了重要而有区别的影响。儿童补助计划也影响了粮食安全, 减少了有残疾人和没有残疾人家庭面临粮食极度短缺的月数。儿童补助计划对残疾人参与有偿工作也产生了影响, 虽不显著却具有重要意义且略有区别。儿童补助计划仅对非残疾儿童入学率产生了影响, 但影响差别并不明显, 可能是由于样本规模不足所致。总体而言, 领取儿童补助计划的残疾人仍面临较高水平的绝对贫困, 与非残疾人群相比, 整体情况仍然较差, 这表明需要调整或补充社会保护以及其他扶贫计划。 يتأثر الأشخاص من ذوي الإعاقة بالفقر بنسب متفاوتة في العالم. وتمثل سياسات الحماية الاجتماعية، بما يشمل التحويلات النقدية، استراتيجيات أساسية للتصدي للفقر "بجميع أشكاله"، ولكن غير الواضح الوقت الحالي مدى تأثير هذه البرامج على الإعاقة. وتفحص الدراسة الفروقات برنامج ليسوتو الخاص بمنح الأطفال الأمن الغذائي والصحة والتعليم وسبل كسب العيش بين وغيرهم باستخدام بيانات مستمدة تجارب مراقبة عشوائية المجتمع. وخلُصت إجمالاً إلى أن لبرنامج آثارٌ كبيرة ومتباينة بالنسبة للأشخاص خلال مؤشرات صحية متعددة (مثلاً نفقات أكثر والتقدير الذاتي للوضع الصحي واحتمال التماس الرعاية الصحية). ولبرنامج أثرٌ الغذائي، خفض عدد الأشهر التي واجهت فيها الأسر المعيشية تضم أفراداً نقصاً كبيراً الغذاء. كما أثر متواضع، هام ومتفاوت مشاركة العمل بأجر. وكان تسجيل المدارس، التفاوت الأثر ليس بكبير؛ ويرجع ذلك الأرجح صغر العينات. وإجمالاً، ورغم كل ذلك، يعيش الذين يستفيدون مستويات مرتفعة الحرمان المطلق، وهم الأغلب وضع أسوء مقارنة بباقي الإعاقة، مما يشير الحاجة برامج مكيفة أو تكميلية للحماية الاجتماعية وغيرها التخفيف حدة الفقر. Em todo mundo, pessoas com deficiência são desproporcionalmente afetadas pela As proteção as quais transferência fundos, estratégias fundamentais tratar “em suas mas atualmente não como esses afetam deficiência. Este estudo examina diferenças do Subvenção Infantil Lesoto (CGP, segurança alimentar, saúde, educação e meios subsistência pessoa sem deficiência, usando dados ensaio randomizado por comunidade. No geral, conclui-se teve impactos importantes diferenciais em vários saúde exemplo, aumento dos autoavaliação da probabilidade procurar assistência médica). O também exerceu na reduzindo lares indivíduos enfrentaram extrema escassez alimento. Apesar houve diferencial contratação trabalhos remunerados. sozinho influenciou matrículas escolares crianças contudo diferença foi significativa, provavelmente devido tamanhos amostra insuficientes. portadoras recebem ainda convivem níveis elevados privação absoluta, além enfrentarem uma situação bem pior comparação necessidade complementar outros redução approximately 15 per cent world’s population has disability (WHO World Bank, 2011). On average, their poorer than those 2011; Banks, Kuper Polack, 2017), association be bi-directional. one hand, vulnerable becoming poor, they less employed, earn average when work, often incur costs related accessible transport, healthcare) (Mitra, 2017; Mitra al., 2017). Further, household may reduce productive activities order provide caregiving support (Palmer 2015). who poor more become disabled live risky unstable environments, have access healthcare. Many studies highlighted risk exclusion amongst households. For example, 80 150 systematic review found monetary measures income, assets) counterparts low- middle-income countries (LMICs) (Banks, Additionally, analysis 22 countries, multidimensionally (face deprivations living standards members) settings (UN, 2018). Still, multidimensional measurements tend measured at level, which mask intra-household differences. particular concern experience lower prioritization division resources face additional challenges improving well-being non-inclusive environments) 2020). individual-level well-being, shown that outcomes areas attendance (Mizunoya, Yamasaki, 2018; Mitra, work Mizunoya 2013; Mactaggart 2018a) healthcare spending UN, Evidence lacking effectiveness improve (Saran, White Kuper, strategy vulnerability, several Sustainable Development Goals (SDG), particularly Goal 1 targets. 11 Target 1.3 Implement nationally appropriate systems all, floors, 2030 achieve substantial coverage vulnerable. defined “the set policies program[me]s aimed preventing protecting against poverty, vulnerability throughout lifecycle, emphasis towards groups” (SPIAC-B, Broadly, instruments include: i) insurance mitigate insurance), ii) assistance, transfers (in kind) groups, iii) labour market interventions, aim promote employment protect workers minimum wage) (ILO, Cash transfer potential among increasingly being scaled-up globally Furthermore, either explicitly targeted allowance), implicitly targeted, given eligibility criteria encompasses large numbers constrained poverty). Literature examining positive general population, improved attendance, greater uptake services nutrition (Taaffe, Longosz Wilson, Bastagli 2019). However, there lack evidence specifically, broadly, (Banks 2016), sub-Saharan Africa. See Bank web portal: Poverty Overview. Impacts differ start with. recipients factors. require cover not just income pay disability-related expenses healthcare, personal assistance) (Mitra rarely account these providing higher values through free assistive device provision, insurance) 2021; non-financial barriers living, availability quality needed goods services, attitudes inaccessible environments such, fewer gains transfer, unless interventions both extra standard 2021). Several Africa introduced decade after 1999 response HIV/AIDS pandemic subsequent increasing orphans (OVC). These caregivers enable them OVC, recognition growing needs households, belief would encourage fostering OVCs extended families, preferable institutionalized care. By definition, orphaned (single double) chronically ill adult. Thus, frequently include adults In way, while specifically targeting Examples types Lesotho’s Grants Kenya’s Transfer Orphans Vulnerable Children (CT-OVC). unconditional programme primary objective OVC reducing malnutrition, status, (Pellerano 2014). started small, donor-funded pilot 2009, 2015 government-run funded programme, reaching 25,000 country 2016). implemented Ministry (MSD) Government Lesotho, along Old Age Pension, feeding, tertiary bursaries targets least child proxy means test (PMT) accompanied validation exercise. Eligible receive quarterly 360–750 maloti 33 currency loti (LSL; plural: maloti). (LSL) (approximately USD 36–75 2013 prices), depending household. 44 prices cited because used article comes evaluation completed published 2014 value constitutes 14 pre-programme consumption levels, 21 adjustment April 2013. An demonstrated some domains, children, overall. small security nutrition, total expenditure (Tiwari linked child-specific needs, education, clothing footwear (Pace result, schooling secondary school-aged girls (Sebastian reduced occurrence intensity deprivation low earning capacity suffered negative economic demographic shocks (Carraro Ferrone, addition members. led farm production (Prifti, Daidone Davis, 2019) occasional irregular Data collected within evaluation, analyses considered current aims gap existing Although intended beneficiaries grant rather individual carries conditionality, meaning can allocate funds see fit. Other evaluations noted adult Potential plausible, example engage livelihood if allows seek improves functioning. exploring Consequently, we vary range domains livelihoods. achieved cluster-randomized controlled trial evaluating (see Pellerano younger age 18. status validation. PMT includes wealth, housing characteristics, demographics asset ownership. Based score, categorized into five categories, ranging one, lowest category, “ultra-poor”, up five, “better off”. Households 18 deemed eligible fall two categories score identified exercise “poorest poor”. therefore directly originally flat rate LSL 120 (approx. 12) month disbursed every quarter. Effective 2013, indexed follows: (1) 1–2 360 (USD 36) quarterly; (2) 3–4 600 60) and, (3) 5 750 75) quarterly. come conducted Oxford Policy Management around expansion CGP, establish impact, effectiveness, efficiency sustainability took place Districts: Qacha’s Nek, Maseru, Leribe, Berea Mafeteng, covering ten Community Councils made 96 electoral divisions (EDs). design (RCT). approach allowed assessment comparing representative (treatment group) group similar benefit programme. Half EDs randomly assigned half arm. Randomization public lottery events each Council. treatment EDs, implementers undertook process, selected according proceeded enrolment. mimicked so group, enrolled until follow-up completed. Intervention groups interviewed 2011 before began (baseline) again been operating years (follow-up). participants arm survey Baseline June August comprised 3,000 fieldwork same time year avoid seasonality bias covered 2,000 One original identify spillover effects (i.e. did meet criterion). included non-eligible communities. article, focus individuals communities) only. main respondent during baseline endline surveys. respondents head most informed member, person reported independent variable interest status. Respondents asked concerning member whether “any physical mental (blind, crippled, etc.)”, responded “yes” “no”. People classified having responding question. We investigated four capture household- well-being: iv) Food level. Where Y outcome interest. P binary recipient zero not. T dummy observation, observation survey, baseline. D indicator disability, representing level indicators, represents disability. X observed years, sex size. Standard errors estimation clustered randomization (villages) sampling weights used. model, β4 group. sum andβ7 66 estimate β7 associated error computed Stata’s lincom command running equation 1. disabi