Assessing Sustainability in Development Interventions

Sustainability is often claimed as an impact in development interventions although there is rarely a shared understanding of what it means, how to design for it, and especially how to assess the likelihood that intended streams of benefits will continue. This chapter asserts that to design and later to evaluate an intervention with sustainable impacts, the intervention must deepen indigenous capabilities to manage the program, to solve problems, and to innovate. The design and implementation also must operate within environmental boundaries, not extracting resources beyond the ability to regenerate or degrading environmental services—that is, design and implementation must incorporate the primacy of the environment. A postprogram evaluation 3–10 years after a program has ended provides evidence on whether the program is likely to have sustainable impacts. A case study of an asset transfer program in Malawi highlights the criteria for evaluating sustainability: deepened capabilities and social capital, reinvestment in program activities, and the development of backward and forward linkages catalyzing growing economic opportunities.

Why Do People Stay Poor?

There are two broad views as to why people stay poor. One emphasizes differences in fundamentals, such as ability, talent, or motivation. The other, the poverty traps view, emphasizes differences in opportunities which stem from access to wealth. To test between these two views, we exploit a large-scale, randomized asset transfer and an 11-year panel of 6,000 households who begin in extreme poverty. The setting is rural Bangladesh and the assets are cows. The data supports the poverty traps view—we identify a threshold level of initial assets above which households accumulate assets, take on better occupations (from casual labor in agriculture or domestic services to running small livestock businesses), and grow out of poverty. The reverse happens for those below the threshold. Structural estimation of an occupational choice model reveals that almost all beneficiaries are misallocated in the work they do at baseline and that the gains arising from eliminating misallocation would far exceed the program costs. Our findings imply that large transfers which create better jobs for the poor are an effective means of getting people out of poverty traps and reducing global poverty.

Long-Term Effects of the Targeting the Ultra Poor Program

This paper studies the long-run effects of a “ big-push” program providing a large asset transfer to the poorest Indian households. In a randomized controlled trial that follows these households over ten years, we find positive effects on consumption (0.6 SD), food security (0.1 SD), income (0.3 SD), and health (0.2 SD). These effects grow for the first seven years following the transfer and persist until year ten. One main channel for persistence is that treated households take better advantage of opportunities to diversify into more lucrative wage employment, especially through migration. (JEL I32, I38, J22, J31, O12, O18)

Asset Transfers among those Accessing the Medicaid Program: Are Wealthy Older Adults Gaming the System?

Medicaid is the largest payer of long-term services and supports and millions of older Americans rely on the means-tested program for health care coverage. There has been longstanding concern that wealthy older adults are taking advantage of the program by divesting assets in order to qualify for coverage. The existing research on the issue is somewhat dated, does not focus on the question of asset transfer, and often lacks a significant longitudinal view. Thus, questions remain about whether states need to tighten asset eligibility rules to prevent the wealthier older adults from accessing the program. This analysis explores longitudinal data from the Health and Retirement Study (1998 to 2016) to determine the extent to which wealthier Americans age 50 and older engage in asset transfer to access Medicaid. Our findings demonstrate that this may occur among a relatively small proportion of wealthy older adults, and that tightening Medicaid eligibility criteria would likely have a small to modest impact on the financial status of the program.

Application of the Ultra-Poverty Graduation Model in understanding community health volunteers’ preferences for socio-economic empowerment strategies to enhance retention: a qualitative study in Kilifi, Kenya

Background A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare coverage, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area in Kenya. Methods This study adopted an exploratory qualitative approach. Using a semi-structured questionnaire, we conducted 10 Focus Group Discussions with the CHVs and 10 Key Informant Interviews with County and Sub-county Ministry of Health and Ministry of Agriculture officials including multi-lateral stakeholders’ representatives from two sub-counties in the area. Data were audio-recorded and transcribed verbatim and transcripts analysed in NVivo. Researcher triangulation supported the first round of analysis. Findings were mapped and interpreted using a theory-driven analysis based on the six-step Ultra-Poverty Graduation Model. Results We mapped the UPG Model’s six steps onto the results of our analyses as follows: (1) initial asset transfer of in-kind goods like poultry or livestock, mentioned by the CHVs as a necessary step; (2) weekly stipends with consumption support to stabilise consumption; (3) hands-on training on how to care for assets, start and run a business based on the assets transferred; (4) training on and facilitation for savings and financial support to build assets and instil financial discipline; (5) healthcare provision and access and finally (6) social integration. These strategies were proposed by the CHVs to enhance economic empowerment and aligned with the UPG Model. Conclusion These results provide a user-defined approach to identify and assess strategic needs of and approaches to CHVs’ socio-economic empowerment using the UPG model. This model was useful in mapping the findings of our qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower CHVs and enhance their retention in our setting.

Impact of an Asset Transfer Program for Income Generation and Food Security Among Ultra-Poor Households in Rural Bangladesh

Objectives An economic development (ED) program, designed based on an ultra-poor graduation approach, was implemented to alleviate poverty and improve food security in rural Bangladesh through asset transfer. This study aims to compare income generation, consumption, and seasonal trends in asset management among ultra-poor households receiving different small assets. Methods A total of 2960 poor or ultra-poor households received (1) 9–26 ducks (n = 2125), (2) 11 chickens (n = 872), and/or (3) vegetable seeds with garden training (n = 2407), depending on living environment. Indicators related to production of assets, income generation, and consumption of assets were collected quarterly over the course of Jan-Dec 2019. Changes in the amount of assets, income generated from assets and asset byproducts, and consumption of assets and asset byproducts were compared across time and asset group type. Results Significant seasonal trends in the amount of production and income were found among all three asset groups over one year (all p < 0.001). The vegetable and duck groups reported their highest mean incomes at the Jan-Mar follow-up, and the chicken group reported its highest mean income at the July-Sept follow-up. A higher proportion of chicken households maintained their baseline asset provisions at one-year than duck households (29.2% vs. 18.2%, p < 0.001). The duck group reported higher average monthly income than the chicken group (811 TK vs. 480 TK; p < 0.001). The duck group consumed a greater number of eggs per month than the chicken group (55 eggs vs. 27 eggs; p < 0.001), while the chicken group consumed a greater number of poultry per month than the duck group (1.65 chickens vs. 0.95 ducks; p < 0.001). Conclusions Duck assets are better short-term income sources for the poor and ultra-poor than chicken assets in rural Bangladesh. Our findings in asset management, income generation, and consumption provide evidence of the impact of the graduation approach on ultra-poor household economies and should be considered in future scale-up of the ED program. Funding Sources World Vision Bangladesh, World Vision Korea, KOICA.