ASSESSING BENEFICIARIES’ APPROPRIATION OF A MULTIFACETED CASH TRANSFER PROGRAM IN NORTHERN TOGO THROUGH COMPREHENSIVE MIXED METHODS

Background and objectives: A pilot cash transfer (CT) program was implemented in the two regions of Togo concentrating the worst nutritional outcomes. The intervention, which aimed at improving child's nutrition and health, combined Behavior Change Communication activities (BCCA) with a monthly cash transfer given to women during the "1,000 days period". A process evaluation was performed to understand beneficiaries' perception and utilization of the program. Methods: Qualitative data, encompassing semi-structured interviews (n=60), focus groups (n=15) and non-participant observations of CT's payments and BCCA (n=40) were collected 8 months after the program's start on a purposive sampling of beneficiaries. Quantitative data were also collected on cash utilization from 400 beneficiaries, after 2 years of intervention. All data were collected in local dialects by experienced surveyors. Qualitative data were fully translated, transcribed and analyzed by thematic content using Nvivo®. Descriptive statistics were produced using R-3.3.3®. Results: Beneficiaries were globally satisfied with the intervention. They particularly appreciated BBCA-CT's synergy that enabled them to acquire knowledge and apply it in practice. They mainly spent CT to meet their child needs: 91% of women declared using CT to buy them food and 68% to cover their health expenditures. This conformist utilization, in line with the program objectives, resulted from a strong social pressure. Despite this tight control, money was not always exclusively used by women nor devoted to children. Nearly 20% of beneficiaries regularly shared half of their CT, mainly with their spouse. Moreover, 30% of women who usually received money from their husband no longer benefited from it since they have entered the program. Another potential adverse effect of CTs lies in birth encouragement: 36% of women thought that CT may promote births, of which 70% said that CT personally encouraged them to have a child. Some women considered pregnancy as a way to continue receiving the CT. More farsighted women anticipated their program's exit by sparing some of their CTs or by initiating income-generating activities (40%). Conclusions: Using mixed-methods enriched our understanding of beneficiaries' appropriation of the intervention, a crucial aspect that will help decoding program's "black box" and explaining its impact.