Originally published at: https://www.unicef.org/malawi/reallives_20191.html

Mangochi, June 2017 - Life is far from easy for half of Malawi’s population. They live below the national poverty line, unable to afford the lowest acceptable standard of living. As many as 3 million or more (22% of the population) are categorized as ultra-poor, with half of them also being labor constrained. This means they are unable to meet their basic needs. They struggle to find food, shelter as well as access to essential services such as education and health. This increases vulnerability particularly among women and children.

In 2003 a World Bank commissioned study in Malawi revealed the extent of poverty in the country, prompting Government of Malawi to pilot the Social Cash Transfer Programme (SCTP) in Mchinji district four years later. Over the years, the programme has grown steadily. Today it reaches about 758,000 beneficiaries in 18 districts. 59% of these are children. They come from families with few or no assets, largely comprising the old, the ill or the young, whose labor yields little or nothing.

Since the 2007 pilot, UNICEF, financially backed by various development partners, namely KfW, EU, Irish Aid and World Bank, has supported Government of Malawi in strengthening and expanding the SCTP to where it is today. 170,000 households now receive a modest amount, ranging from $10 to just above $20 every two months. The amount varies depending on the number of people in the family and the number of children in school. The Dutch Government has supported the piloting of a complementary linkages and referral system in Mangochi and Dedza districts to ensure that SCTP beneficiaries are better connected to existing social services with a special focus on providing HIV testing, counselling and treatment services.

On a recent visit to Malawi, Mieke Vogels, Senior Policy Advisor for the Dutch Government, had the opportunity to learn more about implementation of the linkages and referral component. She held discussions with UNICEF (Malawi Country office as well as regional office staff), key Government of Malawi officials and some of the beneficiaries. UNICEF’s Social Policy Specialist Sophie Shawa indicated that there is a strong system within the central government to oversee and implement the SCTP. The Poverty Reduction and Social Protection unit in the Ministry of Finance, Economic Planning and Development provides critical oversight on all social protection programmes. UNICEF supports in strengthening this unit while also supporting the Ministry of Gender, Children, Disability and Social Welfare which is responsible for the SCTP implementation.

Shawa also indicated that within the current programme many adolescents are being reached, as many of them live in SCTP households. “The linkages and referral programme offers an opportunity to connect adolescents to sexual and reproductive health (SRH) services, which is a critical consideration with HIV prevalence at 10%”, she explained.

Vogels who has extensive experience working in sub-Saharan Africa, stressed the importance of learning and sharing experiences within the region, particularly among those countries with similar contexts.

The SCTP is just one of the components within the National Social Support Programme. Others include the public works programme, school meals, micro credit and village saving and loans schemes. During his meeting with the Dutch envoy, the Director of the Poverty Reduction Division Harry Mwamlima said Government of Malawi is working on strengthening synergies among these components to achieve meaningful change in the lives of beneficiaries. He said as the second National Social Support Programme is being developed, the linkages and referral component has been included as one of the pillars. ‘Beneficiaries can only make progress if linkages are well established, wherever there are cash transfers there must be a linkages and referral component,” said Mwamlima.

He added that as Government continues to strengthen the SCTP system ahead of a scale up to the remaining 10 districts, capacitating district councils is key. He acknowledged the support of the Dutch Government in equipping district councils in Mangochi and Dedza with the necessary skills and resources. Vogels pointed out that it was important to consider increasing domestic funding to the SCTP to make it sustainable.

Later Vogels met Esmie Kainja, Secretary for the Ministry of Gender, Children, Disability and Social Welfare and her SCTP team. District staff within this ministry work closely with community social support committees to conduct the bi-monthly transfers, manage the cases to record any changes in beneficiary status and in the two pilot districts they also facilitate the linkages and referral processes.

Kainja said it is not enough to give money to the poor. “We have to empower beneficiaries so that even if they were no longer receiving the money they stay on their feet, they must be aware of the available services.” She believes that the linkages and referral system, which the Dutch Government is supporting, is contributing to that goal.

© UNICEF Malawi/2017/Phwitiko
Ms Vogels and Principal Secretary in the Ministry of Gender discuss implementation of the linkages and referral component within the social cash transfer programme.

“Beneficiaries are now demanding services, it means they are now empowered,” she explained. The SCTP teams mapped the available services in the two pilot districts; these include agriculture, health, education, entrepreneurship, construction and child protection services. Results from the pilot indicate that the most demanded services are related to education and health. Mieke Vogels observed that the linkage between SCTP beneficiaries and education is particularly important for adolescent girls. “If you send girls to school, you solve half the world’s problems,” she said.

During her field visit, Vogels travelled to Mangochi where she met some of the beneficiaries of her Government’s support. 15-year-old Rukia Rafiki goes to Kausi Primary School. Her younger brother Mwanjali (12) and her cousins 18-year-old Sakina and 7–year-old Diana also go to the same school. Rukia, her brother and cousins live with their grandmother Dawa Kalonga. The four children are orphans and their grandmother is old and disabled. Dawa suffered from a stroke a little over a year ago and has lost the use of her left arm and leg. The family has no source of income, which made them eligible for the SCTP. They now receive 16,000 Malawi kwacha every two months, which is about $21.

Dawa says she uses the money mostly for food and school supplies for the children. She also bought a goat and hopes to sell the meat once she has bred more.

The linkages and referral system connects beneficiaries of the SCTP to essential services in their communities in order to maximize the impact of the SCTP. With funding from the Dutch Government, UNICEF has supported the strengthening of district teams, as well as the recruitment of specialist officers to establish linkages within the SCTP.

For families like Rukia’s this means connecting the children to youth clubs in the area where they can build on their aspirations and benefit from peer support. Rukia’s cousin Sakina is already a member of YONECO youth club. They meet every Wednesday, potentially giving her access to HIV prevention messages as well as HIV testing and counselling. Vogels encouraged Rukia and her cousin Sakina who she met at their school to join the youth clubs and continue working hard in school.

© UNICEF Malawi/2017/Phwitiko
Rukia pictured in class.

In Chiponda village within Mangochi district, Patuma and her 4 children are also SCTP beneficiaries. The 37-year-old widow had no source of income but now uses money from the SCTP to rent a small garden where she grows most of her family’s food. She told Vogels that she also spends some of the money on fertilizer, school supplies and chickens. Patuma is HIV positive and the linkages and referral component ensures regular appointments and treatment for her at Chimala Health Centre. “I need 1000 kwacha to make the trip to the hospital. So I use some of the money I receive to pay for transport,” says Patuma.

Results of the linkages and referral pilot indicate that there is a great demand for services beyond the cash provided. With increased commitment from the Dutch Government, the linkages and referral component will now be rolled out to 6 additional districts: Balaka, Chitipa, Mulanje, Mzimba North, Nsanje and Salima.

After meeting Rukia’s family and Patuma, the Dutch envoy observed that such seemingly small interventions do have a great impact. While in Mangochi she also met the District Commissioner, Moses Chimphepo. She acknowledged the important role of local authorities in ensuring successful implementation of the SCTP as well as the linkages and referral component.

© UNICEF Malawi/2017/Phwitiko
Ms Vogels hears the story of Patuma at her home.

“It’s not just about the money, it is also about the dedication of the local authorities to translate the transfers into something meaningful for the beneficiary communities," reflected Vogels.

For Rukia, “something meaningful” means realizing her dream of becoming a nurse. And for Patuma it means her children can stay in school. 

Photo: St Kitts & Nevis Government

The Government of St. Kitts and Nevis through the Ministry of Community Development, Gender Affairs & Social Services (MoCDGASS) hired Ayala Consulting Corporation on the 10th of September 2014 for the operationalisation of the National Household Registry (NHR). The NHR was conceived as a dynamic Social Protection tool with the objectives to contain up-to-date socio-economic HH information; serve as a common targeting mechanism to identify the poor and vulnerable; guide social assistance and budget allocation; increase Social Protection program coverage and reduce inclusion and exclusion errors; as well as improve efficiency and effectiveness by reducing overlaps in administrative systems.

However, in order to not only meet but surpass the abovementioned objectives, the HHs registered in the NHR need to receive assistance from this Social Protection tool to access existing social services. On that basis, the MoCDGASS hired Ayala Consulting for an eight-month consultancy, starting on December 22, 2016 until August 22 of the same year, to provide technical assistance in designing a Linkages and Referrals (L&R) Model and assisting in its implementation in two Parishes to be selected in conjunction with the client.

The L&R component aims to serve as a system by which household members registered in the NHR can be referred and linked to different available services and programs upon their needs. Thus, it serves as a key component to further assist households, increasing the potential and impact of the NHR.

The scope of the consultancy covers the production of operational documentation describing the L&R processes and protocols, addition of functionalities in the NHR MIS (Management Information System) to support the operationalization of L&R, as well as technical support in the field for implementation of L&R in two Parishes. In addition to the aforementioned eight months of technical assistance, maintenance of the NHR MIS will be provided from the official date of delivery of the system until November 22, 2017.

When cash is not enough

Although Cash Transfer programs have been recognized as an essential tool in Social Protection policies, giving cash to ultra-poor and labor constrained households is sometimes not enough.

These days, no one in the Social Protection arena discusses the benefits of Cash Transfers to improve health and nutrition, increase school enrollment, reduce hunger and starvation, and defeat beneficiaries’ social stigma.

However, beneficiaries need to access other existing social and economic services in addition to cash, to surpass the above mentioned objectives. In this regard, the establishment of Linkages and Referrals (L&R) systems is seen as a practical tool to address the multiple varied vulnerabilities and the exclusions that the ultra-poor face.

Connecting existing services with people in need

In spite of Cash Transfer programs helping communities, several challenges are still affecting ultra-poor and labor constrained households: gender-based violence, barriers to access trade or local businesses, or no access to efficient agriculture techniques. These are urgent issues to be addressed to improve the quality of life of people living in poverty.

To address these challenges, connecting households with pre-existing services (provided by NGOs, public facilities, or private companies) can really make a difference between receiving cash transfers and maximizing the impact of these.

An L&R System is one of the best ways to achieve this, by connecting beneficiaries with service providers to access complementary services.

The L&R system targets those households that lack able-bodied adults to generate enough resources to support their members and evaluates their specific and most urgent needs. Then, these households are referred to an existing local service provider to meet demand.

L&R systems use a systematic protocol in which three important stakeholders are in continuous contact: beneficiaries, service providers, and extension workers acting as local experts connecting the first two.

L stands for Link, R stands for Referral

The key to success of this system is to connect cash transfer recipients with pre-existing services to reinforce the capacities, human development, and social opportunities of beneficiary households with the help of specialized service providers at community level.

To achieve this, local community members, known as Extension Workers, interview households and study the challenges they are facing in six different sectors: education, health, trade, social services, agriculture and livestock, and finally, construction.

The Extension Worker links the household member with a selected Service Provider, previously interviewed, that best fits the household needs, type of service required, proximity, etc.

Finally, the household accesses the referred service and informs the Extension Worker periodically about the referral development.

Different contexts, different methodologies

International experience has been gathered worldwide regarding this topic in recent years. In some cases, L&R have been connected with Cash Transfer programs while in other cases, these have emerged as systems intended to reinforce solutions to specific problems, such as implementing health plans aimed to provide assistance to communities and people living with HIV and AIDS.

Despite the fact that these initiatives pursue different objectives, the common goal of connecting local communities with services has been used in several countries including India through the International HIV/AIDS Alliance, in Swaziland with the support of USAID, and in Kenya where AMREF and partners oriented their efforts to provide access to prevention, care, treatment, and support for people living with HIV/AIDS.

Relevant cases, such as the Prospera Program for Social Inclusion in Mexico, are focused on linking communities with institutional services to increase employability, financial inclusion, and nutrition advocacy.

Social services are also represented in programs such as Bolsa Familia in Brazil, (which was expanded to promote the access of beneficiaries to literacy courses, housing programs, energy, or women empowerment through professional training).

The recipe for success

All these experiences prove that L&R are becoming valuable tools to support and complement other Social Protection programs.

To design an L&R system, it is essential to shift from informal relationships to formal linkages; hence, a strong protocol design is necessary to make the engine work.

All successful L&R systems have invested resources and time assessing and strengthening organizational infrastructure to boost the capacity of the system.

It is also mandatory to develop and implement referral-specific policies and protocols to make these systems sustainable through time.

    Experiences from the field

    When Ayala Consulting was hired to implement an L&R pilot in Malawi to assist beneficiaries of the Social Cash Transfer Program (SCTP)
    to access existing social services, three main processes were designed:

  • Supply Capacity Analysis: Available service providers were identified and a service directory was developed based on gathered data.
  • Referrals: Every beneficiary household member’s needs were identified and referred to the service provider matching the case.
  • Follow-up and Monitoring: The beneficiary household members were revisited or met at the Cash Transfer payment point to follow-up their access to the service.

Now it is your turn to make a difference. Are you interested in helping people in need to access services? Then, use a Linkages and Referrals system.

The Malawi Social Cash Transfer Programme (SCTP), locally known as the Mtukula Pakhomo, is an unconditional cash transfer programme targeted to ultra-poor, labour-constrained households. This programme is implemented by the Ministry of Gender, Children, Disability and Social Welfare (MoGCDSW). Financial support derives from various technical and financial Development Partners including KfW, Irish Aid, the European Union, World Bank and the Government of Malawi.

The SCTP began as a pilot in Mchinji district in 2006 and after the first pilot year, expanded to six other districts. Since 2012, Ayala Consulting has been hired to redesign the programme’s project cycle processes and provide technical assistance for its implementation (including the provision of training/capacity building of the local Malawian team, supervision and operational support), development of a Management Information System (MIS), implementation of a Monitoring & Evaluation System, procurement support and assistance in developing a Financial Management System as well as strengthening the financial team. As such, the Ayala team is responsible for the day-to-day management of the SCTP operations and implementation of the field work activities.

As stated in the Endline evaluation, executed by the University of North Carolina at Chapel Hill in October - November 2015, the programme has experienced impressive growth beginning in 2012, and most notably over the last two years. At present, the programme covers eighteen of the twenty-eight districts in Malawi and as of June 2016 has reached around 170,000 households, 757, 000 household members and 459,000 beneficiary children (aged 0-17 years old). As such, without any doubt, the SCTP has significantly and positively transformed the lives of its beneficiaries. Upon completion of the evaluation, it is evident that the programme has succeeded in improving the wellbeing of its beneficiaries in every aspect that was measured; all programme objectives were reached and goals met including an increase in consumption levels, schooling, health, and investment capabilities among all households, not just among the very poorest. A resounding triumph for all involved, well-done!

The Endline evaluation describes the impacts of the programme on individuals, households, and communities, twenty-eight months after baseline data was collected (interpreted as two-year impacts of the programme on beneficiaries), providing a range of indicators covering the main objectives of the programme. Results from the Endline evaluation shows solid impacts across almost all objective areas.

Key Findings of Programme Objective Areas at Endline:

  1. Impacts on Consumption, Food Security and Material Needs

With larger impacts amongst the poorest, the SCTP has achieved its primary objective of ensuring food security and consumption among the ultra-poor labour constrained households. This represents an increase of 23% over baseline and 53% amongst the poorest households.

Food security has improved with an increase by 15% in the number of meals per day, and programme households 20 percentage points less likely to worry about food.

Diet diversity has improved, with significant increases in the budget share devoted to meats, fish and poultry products.

Strong positive impacts were also generated on the material wellbeing of children, indicating that the proportion of children with a pair of shoes, access to a blanket and a change of clothes has risen from 12% at Baseline to 50%.

  1. Impacts on Household Production and Assets

Significant positive impacts on the ownership of agricultural assets, household durable goods, crop production and livestock production, indicating that the transfer is being used productively. However, there is still room for further improvements in crop production attributable to the low uptake of agro-chemical, improved seed varieties and irrigation.

  1. Impacts on Health

Generally, although differing in magnitude, significant impacts were generated on the occurrence of illness or injury in the past two weeks, seeking treatment at a health facility for illness/injury, and households reporting at least one member with any illness or injury within the past two weeks. As it relates to treatment-seeking behaviours and expenditure levels for illness/injury, strong impacts have been generated for the poorest 50% of beneficiary households.

  1. Impacts on Young Child Health

On average, positive programme impacts were produced on the prevalence of wasting among children 6-59 months old and on treatment-seeking behaviours for beneficiary children with fever. However, as it relates to other key individual and household level health indicators, there was slight (e.g. the percentage of children that are fed solid foods at least three times per day) to no programme impact (e.g. children who had consumed vitamin A-rich foods in the past day or the incidence of child diarrhoea, fever or cough during the two weeks prior to the survey) due to the fact that SCTP households have relatively few children under five.

  1. Impacts on Schooling and Child Labour

There are strong effects of the programme on children’s school participation across all age groups and an increase in per-child education expenditure. As such, there is an increase in enrolment as well as an increase in the regular participation in school.

As it relates to child work, the SCTP increases children’s participation in household chores (although impacts on hours of household chores are limited) and participation in hazardous economic activities.

  1. Transitions to Adulthood among Youth

Overall, the SCTP has potential to positively impact the transition to adulthood, particularly related to sexual debut, sexual risk taking, including sexual violence and social support. This evaluation was directed to youth ages 13 to 19 at Baseline (14 to 21 at Midline and 15 to 22 at Endline).

As it relates to subgroups, larger impacts are amongst poorer households (e.g. mental health) and are highly gendered - driven by girls (sexual risk taking) or boys (sexual debut).

  1. Impacts on Subjective Welfare

The well-being of care-givers of orphans and vulnerable children have a significant positive impact on their physical health with a decrease in morbidity and an increase in the use of curative care.

Self-reported quality of life, future outlook, and stress have all improved thus showing that the SCTP has had a remarkable effect on the subjective well-being and mental health of participants; revealing a 22% increase in the quality of life score and an 11% change in the stress scale.

Nevertheless, stress and worry continue to affect beneficiary households, especially those that are labour-constrained and lack social support network.

Keeping all this in mind and using the monetized comprehensive estimates of impact provided in the Endline evaluation, it is safe to say that after two years, these impacts tend to be higher among the poorest households, emphasising that the value of the transfer matters for both the range and depth of impact and that unconditional cash transfer programmes to the ultra-poor can be an important part of an inclusive growth strategy even in very poor countries.

  • Client: UNICEF.
  • Funder: UNICEF.
  • Country: Malawi.
  • Years: 2015.

Ayala Consulting is contracted to provide technical assistance to the Ministry of Gender, Children, Disability and Social Welfare (MoGCDSW) in the design of a Linkages and Referrals (L&R) System for the Mtukula Pakhomo - Social Cash Transfer Programme (SCTP) - in Malawi and pilot said system in two Districts. Subsequently, the contract was amended at the end of 2015 to also include a communication component for the L&R System.

The consultancy, from June 2015 - November 2016, will include the following activities:

  • Develop the Operations Manual and Technical Annexes of the L&R System by identifying beneficiary needs and services offered, as well as create a model to assist beneficiaries in their social and human development, together with Service Providers (SPs).
  • Develop the Management Information System (MIS) software application to support the L&R System implementation as well as the respective technical documents.
  • Undertake a pilot project in two Districts, Mangochi and Dedza, to apply the instruments developed for the L&R System. As of May 2016, Mangochi covers 20,177 households and 99,806 members while Dedza covers 15,867 households and 68,572 members.
  • Develop communication materials to support the implementation of the L&R System.

Additional Information about the L&R System

The L&R System is an additional component of the SCTP as most of its activities are executed in sync with the current implementation of the programme. The objective of the L&R System is to assist SCTP beneficiaries, in a more systematic and standardized manner, to access existing social services and thus maximize the impact of the transfers they are currently receiving. It comprises three main processes which are: (i) Supply Capacity Analysis; (ii) Referrals; and (iii) Follow-up and Monitoring.

The Supply Capacity Analysis (first process of the project cycle) identifies SPs who are willing to participate in the overall SCTP L&R Process and thus offer their services to its beneficiaries. Once the data is collected for all SPs within the District - through a massive data collection at BOMA, Traditional Authority (TA) and Village Cluster (VC) Levels - it is entered into the MIS and analysed to determine their eligibility. If the SP is deemed eligible, an agreement is reached thus confirming their participation in the L&R System as well as signalling that SPs can commence attending to SCTP beneficiaries. Following this, is Referrals (second process of the project cycle) which begins with the sensitization of SCTP beneficiaries informing them about the process, the available services and their providers and its benefits, while simultaneously promoting dialogue between beneficiaries and Extension Workers (EWs). Referrals are mainly operational at SCTP pay points (manual modality) and case management meetings (e-payment modality), or through home visits conducted along with the respective referrals follow-up (mainly executed by L&R Officials) and monitoring (independent M&E Officials). This data is also entered into the MIS and later on further informs the Follow-up and Monitoring Process (third and final process of the project cycle).

Simultaneously, throughout the processes, on-going data collection of new SPs or the re-assessment of existing SPs is being carried-out. These three processes mentioned above are continuous, concurrent and synchronized with the other SCTP activities (such as transfers and case management).