Cash for assets during acute food insecurity: an observational study in South Sudan

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.