C The Cash Learning Partnership THE STATE OF THE WORLD’S CASH REPORT Agencies have recognized the need to build the evidence base on achieving sectoral outcomes through CTP in multiple sectors, and are acting on this BOX 6.5 PERSPECTIVES ON EVIDENCE Research for this report (surveys, interviews and FGDs) revealed FOR USE OF CTP IN SECTORS that, overall, respondents note a lack of sufficient evidence for 1/2 the appropriate use of cash and vouchers in some sectors. Practitioners agree that sufficient evidence is Similarly, existing systematic studies and syntheses, as well as 128 available about how to use cash and vouchers sector-wide reviews, point to very limited evidence in some appropriately in different sectors. sectors, including health, nutrition, WaSH, shelter and protection. There is a need to build credible evidence about sector outcomes. This is both in terms of the effectiveness of different types of CTP, and more broadly regarding the use of a range of aid modalities. Various sectors are beginning to gather and review existing evidence, and develop research agendas, probably stimulated in part by policy developments. The work of the Global Health Cluster is a good example of progress (see Box 6.6). Other global clusters, e.g., WaSH and education, are also studying this issue, and there are multiple examples of collective and agency-level initiatives to identify sectoral evidence gaps, and begin to address them through research and learning.129 BOX 6.6 RESEARCH AGENDA-SETTING ON CTP FOR HEALTH AND NUTRITION Recognizing the limited evidence base for CTP for health and nutrition in humanitarian assistance, the World Health Organization (WHO) and the Global Health Cluster commissioned a study to identify research priorities. A total of 189 suggested research questions were collected through an online survey and a face-to-face group session. These questions were then reviewed by an advisory group based on four criteria (answerability/ feasibility, fills important knowledge gap, maximum potential for improving health or nutrition outcomes, effect on equity) using a five-point scale. Content analysis was used to identify and rank research categories. The top three categories in terms of the number of questions (NB. a single question could fall into more than one category) were: — Modalities (i.e., different types of CTP and comparison with each other and with direct support to access services and goods) — Outcomes & Impact (e.g., health and nutrition outcomes and systems, links to development, etc.) — Intermediate Outcomes (e.g., access to and utilization of care and goods, behaviour change, etc.) The study leads noted that the findings are illustrative rather than exhaustive, due to limitations in the process, and the complexity and relative novelty of the topic. Nevertheless, the results serve as valuable guidance for researchers, policy makers, implementers and funders. Source: Global Health Cluster (2017) Research agenda-setting on cash programming for health and nutrition in humanitarian settings. As noted in Chapter 2, sectoral concerns often focus on MPGs with respect to achieving and measuring outcomes. MPGs as a form of cash transfer explicitly designed to address a range of basic needs are quite new, hence, there is currently little evidence concerning how they contribute to achieving different sectoral outcomes. There is also little evidence of how and which activities implemented in tandem with MPGs (often referred to as ‘complementary programming’, or ‘cash plus’) are effective in contributing to reaching intended sectoral outcomes and/or increasing overall well-being. It was also noted by a respondent that, ideally, we should also test the comparative effectiveness of a given complementary activity in relation to the provision of more cash per beneficiary, although this may be challenging in practice. Studies in the pipeline will help to answer these complex, and often very context-specific questions. For example, the Basic Needs Assessment (BNA) methodology being developed by the ERC consortium (see Annex 2.5 for the Nigeria case study) has the use of MPGs alongside other complementary activities at its foundation, and outputs from the pilots in Nigeria and Ethiopia will contribute to understanding in this space. Another example is UNHCR’s study (due to be completed in early 2018), comprising a desk review and two case studies, with the objective of providing evidence on the effectiveness of MPGs and complementary programming in reaching sectoral outcomes. A further study on the related topic of ‘multimodal’ 128 e.g. IASC Strategic Note and Doocy et al., and UNHCR review of Cash Based Interventions in WASH programmes 129 Includes literature and programming reviews - e.g. Protection Outcomes in Cash Based Interventions A Literature Review – Berg and Seferis (2015), UNHCR sectoral CTP evidence reviews for WASH and health – and research e.g. IRC’s planned research relating to health and protection outcomes 83