Background
Methods
Outcome measures
Sampling
Region | UNHCR MPC Recipients by Region at Enrollment | Enrolled Sample (n = 1005) | Analyzed Sample (n = 617) | ||||||
---|---|---|---|---|---|---|---|---|---|
Intervention (n = 497) | Control (n = 508) | Intervention (n = 173) | Control (n = 444) | ||||||
N | % | N | % | N | % | N | % | ||
North | 23.0% | 112 | 22.5% | 109 | 21.5% | 71 | 41.0% | 89 | 20.0% |
BML | 12.5% | 65 | 13.1% | 50 | 9.8% | 20 | 11.6% | 44 | 9.9% |
Bekaa | 58.0% | 278 | 55.9% | 306 | 60.2% | 60 | 34.7% | 279 | 62.8% |
South | 6.4% | 42 | 8.5% | 43 | 8.5% | 22 | 12.7% | 32 | 7.2% |
BASELINE | ENDLINE | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
MPC HHs (N = 173) | Control HHs (N = 444) | P value | MPC HHs (N = 168) | Control HHs (N = 375) | P value | |||||
Principal Applicant/Household Head Characteristics | ||||||||||
Female sex | 68 | (39.3%) | 212 | (47.7%) | 0.059 | 65 | (38.7%) | 175 | (46.7%) | 0.084 |
Age (mean years) | 39.7 | (9.0) | 38.0 | (12.1) | 0.101 | 40.9 | 9.2 | 38.8 | 11.8 | 0.041 |
Highest level of education | ||||||||||
None | 52 | (30.2%) | 101 | (22.9%) | 0.007 | 46 | (27.4%) | 66 | (17.6%) | 0.001 |
Primary school | 91 | (52.9%) | 215 | (48.8%) | 100 | (59.5%) | 207 | (55.3%) | ||
Preparatory school | 22 | (12.8%) | 72 | (16.3%) | 16 | (9.5%) | 56 | (15.0%) | ||
Secondary school | 7 | (4.1%) | 53 | (12.0%) | 6 | (3.6%) | 45 | (12.0%) | ||
Marital status | ||||||||||
Married | 155 | (89.6%) | 408 | (91.9%) | 0.248 | 150 | (89.3%) | 337 | (89.9%) | 0.984 |
Widowed | 6 | (3.5%) | 21 | (4.7%) | 6 | (3.6%) | 11 | (2.9%) | ||
Never married / Divorced | 4 | (2.3%) | 5 | (1.1%) | 3 | (1.8%) | 7 | (1.9%) | ||
Household Demographic Characteristics | ||||||||||
Household size (mean) | 7.6 | (2.5) | 6.0 | (2.4) | < 0.001 | 7.5 | 2.5 | 6.0 | 2.1 | < 0.001 |
Dependency ratio a (mean) | 2.3 | (1.0) | 1.7 | (1.0) | < 0.001 | 2.4 | 1.2 | 1.7 | 1.1 | < 0.001 |
Multiple UNHCR registration cases (%) | 5 | (2.9%) | 11 | (2.5%) | 0.772 | 9 | (5.4%) | 31 | (8.3%) | 0.230 |
Vulnerable members (%) | ||||||||||
Child(ren) < 5 yrs | 136 | (78.6%) | 317 | (71.4%) | 0.068 | 111 | (66.1%) | 250 | (66.7%) | 0.892 |
Child(ren) ≤ 17 yrs | 172 | (99.4%) | 426 | (95.9%) | 0.025 | 166 | (98.8%) | 364 | (97.1%) | 0.219 |
Older adult(s) (> 60 yrs) | 16 | (9.2%) | 51 | (11.5%) | 0.422 | 20 | (11.9%) | 53 | (14.1%) | 0.482 |
Member with a chronic health condition | 27 | (15.6%) | 66 | (14.9%) | 0.817 | 60 | (35.7%) | 136 | (36.3%) | 0.901 |
Member w/ disability or that needs daily support | 23 | (13.3%) | 46 | (10.4%) | 0.299 | 45 | (26.8%) | 68 | (18.1%) | 0.022 |
Living Conditions | ||||||||||
Residence type | ||||||||||
Apartment or house | 61 | (35.3%) | 211 | (47.5%) | 0.006 | 65 | (38.7%) | 142 | (37.9%) | 0.292 |
Single room | 79 | (45.7%) | 159 | (35.8%) | 73 | (43.5%) | 149 | (39.7%) | ||
Temporary shelter b | 21 | (12.1%) | 61 | (13.7%) | 16 | (9.5%) | 58 | (15.5%) | ||
Other c | 12 | (6.9%) | 13 | (2.9%) | 14 | (8.3%) | 26 | (6.9%) | ||
Residence arrangement | ||||||||||
Rented | 159 | (91.9%) | 401 | (90.3%) | 0.206 | 156 | (92.9%) | 345 | (92.0%) | 0.672 |
Hosted for free / rent paid by NGO/charity | 12 | (6.9%) | 42 | (9.5%) | 8 | (4.8%) | 22 | (5.9%) | ||
Owned | 2 | (1.2%) | 1 | (0.2%) | 4 | (2.4%) | 6 | (1.6%) | ||
Shared living space | 156 | (90.7%) | 383 | (86.3%) | 0.135 | 167 | (99.4%) | 375 | (100%) | 0.135 |
Crowding (mean # people/sleeping room) | 4.5 | (1.9) | 3.6 | (1.7) | < 0.001 | 4.3 | 2.0 | 4.1 | 1.9 | 0.228 |
Study implementation
Data analysis
Results
Study sample characteristics
BASELINE | ENDLINE | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
MPC HHs (N = 173) | Control HHs (N = 444) | P value | MPC HHs (N = 168) | Control HHs (N = 375) | P value | |||||
Household Income and Expenditures (past month; mean US$ a) | ||||||||||
Income (excluding humanitarian assistance) | 389 | (427.9) | 295 | (354.4) | 0.005 | 440 | (628.9) | 371 | (390.8) | 0.119 |
Total expenditures | 693 | (371.2) | 553 | (372.6) | < 0.001 | 778 | (357.4) | 695 | (334.9) | 0.009 |
Total Humanitarian Assistance (past month) b | ||||||||||
Any regular transfer (% of HHs) | 173 | (86.1%) | 444 | (76.6%) | 0.009 | 168 | (86.9%) | 375 | (59.5%) | < 0.001 |
Amount received (mean US$a per HH) | 304 | (109.8) | 168 | (92.5) | < 0.001 | 297 | (141.2) | 113 | (117.8) | < 0.001 |
Amount received (mean US$a per HH member) | 42 | (15.3) | 30 | (17.1) | < 0.001 | 43 | (25.9) | 20 | (21.3) | < 0.001 |
In-kind assistance (past 3 months) | 2 | (1.2%) | 10 | (2.3%) | 0.332 | 19 | (11.3%) | 47 | (12.6%) | 0.671 |
WFP Food Assistance (past month) | ||||||||||
Current WFP recipients | 143 | (82.7%) | 334 | (75.2%) | 0.048 | 168 | (85.7%) | 375 | (57.1%) | < 0.001 |
Amount received (mean US$a per HH) | 190 | (62.6) | 143 | (70.7) | < 0.001 | 186 | (68.1) | 146 | (48.0) | < 0.001 |
Amount received (mean US$a per HH member) | 26 | (6.0) | 25 | (12.5) | 0.519 | 25 | (5.2) | 25 | (7.3) | 0.424 |
Transfer modality | ||||||||||
E-Voucher | 137 | (95.8%) | 312 | (93.4%) | 0.309 | 168 | (100%) | 367 | (97.9%) | 0.056 |
Multipurpose Cash Transfer | 6 | (4.2%) | 22 | (6.6%) | 0 | (0.0%) | 8 | (2.1%) | ||
Asset Sales and Borrowing | ||||||||||
Sold assets in past 3 months (%) | 14 | (8.1%) | 42 | (9.5%) | 0.712 | 17 | (10.1%) | 74 | (19.7%) | 0.006 |
Borrowed money in past 3 months (%) | 77 | (44.5%) | 166 | (37.4%) | 0.266 | 154 | (91.7%) | 331 | (88.3%) | 0.431 |
Current debt | ||||||||||
Any Debt | 142 | (86.1%) | 321 | (77.5%) | 0.021 | 152 | (92.7%) | 326 | (91.1%) | 0.536 |
Amount of debt (among those w/ debt; mean US$a) | 536 | (628.8) | 516 | (674.3) | 0.740 | 843 | (1022.4) | 711 | (781.0) | 0.106 |
Health service utilization
UNADJUSTED CHANGE OVER TIME | ADJUSTED CHANGE OVER TIME a | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MPC HHs | Control HHs | DiD | MPC HHs | Control HHs | DiD b | Overall % | Effect Size | R2 | |||||||
% | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | ||||
Most Recent Childhood Illness | |||||||||||||||
Sought and received medical care | -0.4% | (−3.6,2.8) | −1.2% | (−5.6,3.1) | 0.9% | (−4.5,6.2) | 0.7% | (−2.9,4.3) | −2.3% | (−7.4,2.7) | 3.0% | (−2.9,9.0) | 94.6% | 3.2% | 0.059 |
Able to obtain prescribed meds | 0.2% | (−2.0,2.3) | −0.3% | (−2.4,1.7) | 0.5% | (−2.5,3.4) | 1.3% | (−0.6,3.3) | −1.4% | (−3.8,1.0) | 2.8% | (−0.6,6.1) | 98.4% | 2.8% | 0.029 |
Outpatient visit | 11.0% | (3.5,18.5) | 5.6% | (−0.4,11.5) | 5.4% | (−4.2,15.0) | 11.1% | (2.8,19.3) | 6.7% | (−0.4,13.7) | 4.4% | (−6.3,15.1) | 87.4% | 5.1% | 0.032 |
Emergency room visit | −11.9% | (− 18.5,-5.3) | − 12.6% | (− 17.6,-7.5) | 0.7% | (−7.7,9.0) | − 12.3% | (− 19.4,-5.2) | −13.9% | (−20.0,-7.8) | 1.6% | (− 7.6,10.8) | 8.1% | 19.9% | 0.071 |
Hospital admission | 0.9% | (−2.6,4.4) | 7.0% | (3.6,10.3) | −6.1% | (−10.9,-1.2) | 1.2% | (−3.0,5.4) | 7.3% | (3.5,11.0) | − 6.1% | (− 11.7,-0.4) | 4.5% | −133.5% | 0.043 |
Care not sought b/c of cost | −33.3% | (−90.6,23.9) | −11.4% | (−30.9,8.1) | −21.9% | (−82.4,38.5) | −53.3% | (− 143.1,36.4) | − 20.3% | (−44.6,4.0) | − 33.0% | (− 122.8,56.8) | 87.7% | −37.7% | 0.379 |
All care not received due to cost | 39.4% | (30.0,48.8) | 27.5% | (20.7,34.4) | 11.9% | (0.2,23.5) | 39.8% | (30.6,49.1) | 20.5% | (12.8,28.3) | 19.3% | (7.3,31.2) | 24.6% | 78.3% | 0.177 |
Most Recent Adult Acute Illness | |||||||||||||||
Sought and received medical care | 4.3% | (−4.1,12.6) | −5.2% | (−11.6,1.1) | 9.5% | (−1.0,20.0) | 6.9% | (−2.8,16.6) | −4.4% | (−10.8,2.1) | 11.3% | (−0.3,22.9) | 88.9% | 12.7% | 0.047 |
Able to obtain prescribed meds | −2.9% | (−6.1,0.4) | 1.1% | (−1.8,3.9) | −3.9% | (−8.2,0.4) | −4.0% | (− 8.2,0.3) | 0.0% | (−2.9,2.9) | − 4.0% | (− 8.7,0.7) | 98.1% | − 4.1% | 0.031 |
Outpatient visit | 4.3% | (−5.5,14.1) | 6.6% | (0.4,12.7) | −2.3% | (−13.8,9.3) | 6.5% | (−3.9,16.8) | 7.3% | (0.7,14.0) | −0.9% | (−13.2,11.4) | 90.5% | −1.0% | 0.037 |
Emergency room visit | −8.8% | (−17.8,0.2) | −9.0% | (−14.6,-3.5) | 0.3% | (−10.3,10.8) | −9.3% | (− 19.0,0.4) | − 9.4% | (−15.6,-3.3) | 0.1% | (−11.3,11.6) | 7.2% | 2.1% | 0.061 |
Hospital admission | 4.5% | (0.6,8.3) | 2.5% | (−0.3,5.2) | 2.0% | (−2.7,6.7) | 2.8% | (−0.3,6.0) | 2.1% | (−0.8,5.0) | 0.7% | (−3.5,5.0) | 2.3% | 32.1% | 0.041 |
Care not sought b/c of cost | −33.3% | (−65.7,-1.0) | −12.1% | (−23.8,-0.4) | − 21.2% | (−55.6,13.2) | −36.9% | (−74.9,1.2) | −12.3% | (− 25.8,1.2) | − 24.6% | (− 62.3,13.2) | 88.0% | − 27.9% | 0.367 |
All care not received due to cost | 22.0% | (9.1,34.8) | 15.9% | (6.8,24.9) | 6.1% | (−9.6,21.8) | 17.9% | (4.0,31.8) | 13.0% | (3.1,22.9) | 4.9% | (−11.9,21.8) | 30.0% | 16.5% | 0.078 |
Adult Chronic Illness | |||||||||||||||
Sought and received medical care | 2.3% | (−7.7,12.3) | 4.4% | (−3.8,12.6) | −2.1% | (−15.0,10.8) | 6.4% | (−4.6,17.5) | 2.7% | (−5.7,11.0) | 3.8% | (−8.7,16.3) | 93.9% | 4.0% | 0.042 |
Ever faced difficulties obtaining meds | 0.0% | (−21.4,21.5) | 11.7% | (−2.7,26.1) | −11.6% | (−37.5,14.2) | −10.6% | (−34.2,13.1) | 14.2% | (−3.2,31.7) | − 24.8% | (−53.6,4.0) | 73.6% | − 33.7% | 0.072 |
General practitioner visit(s) | −20.3% | (−39.8,-0.7) | −15.3% | (−30.2,-0.3) | −5.0% | (− 29.6,19.6) | − 23.1% | (−45.9,-0.3) | −27.6% | (− 42.7,-12.5) | 4.5% | (− 22.9,32.0) | 62.5% | 7.2% | 0.096 |
Specialist visit(s) | −7.8% | (−30.0,14.4) | −14.0% | (− 26.6,-1.5) | 6.3% | (−19.2,31.8) | − 14.4% | (− 38.3,9.5) | − 13.6% | (− 27.8,0.5) | −0.7% | (− 29.1,27.6) | 70.2% | −1.1% | 0.089 |
Hospital visit(s) | 0.2% | (−16.0,16.4) | 0.1% | (−13.1,13.3) | 0.0% | (−20.8,20.9) | −1.5% | (− 22.2,19.2) | −9.3% | (− 24.4,5.7) | 7.9% | (− 18.6,34.4) | 27.5% | 28.6% | 0.118 |
Care not sought b/c of cost | 100% | – | 0.0% | – | 100% | – | 100.0% | – | 0.0% | – | 100% | – | 82.6% | – | 1.000 |
All care not received due to cost | 6.0% | (−17.3,29.3) | 27.6% | (14.3,40.9) | −21.6% | (−48.4,5.3) | −3.2% | (− 29.6,23.3) | 25.1% | (9.3,40.8) | −28.2% | (−59.1,2.6) | 40.2% | −70.3% | 0.103 |
Cannot afford medication | 2.6% | (−21.5,26.7) | 19.2% | (4.1,34.3) | − 16.6% | (−45.1,11.8) | −5.1% | (−31.1,20.9) | 22.1% | (3.6,40.5) | −27.2% | (−59.5,5.0) | 62.0% | −43.9% | 0.078 |
Health expenditures
UNADJUSTED CHANGE OVER TIME | ADJUSTED CHANGE OVER TIME b | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MPC HHs | Control HHs | DiD | MPC HHs | Control HHs | DiD c | Overall Mean/% | Effect Size | R2 | |||||||
% | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | ||||
Most Recent Childhood Illness | |||||||||||||||
Health Facility Payments for OP Cared | |||||||||||||||
Any payment for OP care at facility | 3.1% | (−5.6,11.8) | 0.6% | (− 5.1,6.3) | 2.5% | (−7.9,12.9) | 4.3% | (−5.1,13.7) | −0.2% | (−6.3,5.9) | 4.5% | (−6.7,15.8) | 87.8% | 5.2% | 0.027 |
Total paid at facility for visit (all HHs) | 0.19 | (−0.9,1.3) | 0.20 | (−0.5,0.9) | −0.01 | (−1.3,1.2) | 0.34 | (−0.8,1.5) | − 0.02 | (− 0.7,0.7) | 0.36 | (− 1.0,1.7) | 1.37 | 26.2% | 0.035 |
Medication Costs at Pharmacy/Elsewhere | |||||||||||||||
Any payment for medication outside facility | 15.7% | (4.4,27.0) | 15.0% | (6.2,23.8) | 0.7% | (−13.6,15.0) | 14.8% | (2.2,27.4) | 4.8% | (−5.0,14.7) | 9.9% | (−6.0,25.8) | 57.0% | 17.4% | 0.059 |
Total paid for medication (all HHs) | 1.61 | (0.2,3.0) | 1.81 | (0.7,2.9) | −0.19 | (−1.9,1.6) | 1.54 | (0.0,3.1) | 0.51 | (−0.7,1.7) | 1.03 | (−0.9,3.0) | −2.49 | −41.3% | 0.058 |
Total Amount Paid for Illnesse | |||||||||||||||
Any expense for most recent illness | 4.6% | (−4.0,13.3) | 6.7% | (0.5,12.9) | −2.0% | (−12.7,8.6) | 5.5% | (−3.9,15.0) | 5.1% | (−1.9,12.2) | 0.4% | (−11.0,11.8) | 86.3% | 0.5% | 0.048 |
Total cost for most recent illness (all HHs) | 0.59 | (−0.5,1.7) | 1.01 | (0.2,1.8) | −0.41 | (−1.8,0.9) | 0.71 | (−0.5,1.9) | 0.64 | (−0.3,1.5) | 0.07 | (−1.4,1.5) | 1.52 | 4.6% | 0.056 |
Most Recent Acute Adult Illness | |||||||||||||||
Health Facility Payments for OP Cared | |||||||||||||||
Any payment for OP care at facility | −11.9% | (−20.8,-2.9) | 0.7% | (−6.5,7.9) | −12.6% | (−24.1,-1.1) | − 14.5% | (− 23.4,-5.5) | −1.1% | (−9.0,6.8) | − 13.4% | (− 25.4,-1.3) | 88.1% | −15.2% | 0.055 |
Total paid at facility for visit (all HHs) | −1.34 | (− 2.4,-0.3) | −0.01 | (− 0.8,0.8) | − 1.34 | (−2.7,0.0) | − 1.57 | (− 2.7,-0.5) | − 0.33 | (−1.3,0.6) | − 1.24 | (−2.7,0.2) | 1.64 | −75.6% | 0.057 |
Medication Costs at Pharmacy/Elsewhere | |||||||||||||||
Any payment for medication outside facility | −6.6% | (−21.1,7.9) | 1.9% | (−8.5,12.4) | −8.6% | (−26.4,9.3) | − 11.3% | (− 26.7,4.2) | −3.5% | (− 15.2,8.3) | − 7.8% | (− 27.0,11.5) | 56.6% | − 13.7% | 0.044 |
Total paid for medication (all HHs) | −0.92 | (− 2.8,0.9) | − 0.04 | (− 1.3,1.3) | − 0.88 | (− 3.1,1.4) | − 1.37 | (−3.3,0.6) | − 0.67 | (− 2.1,0.8) | −0.70 | (− 3.1,1.7) | − 2.45 | 28.6% | 0.047 |
Total Amount Paid for Illnesse | |||||||||||||||
Any expense for most recent illness | −12.1% | (−22.8,-1.5) | −0.6% | (− 8.8,7.5) | − 11.5% | (− 24.9,1.9) | − 13.2% | (− 24.2,− 2.1) | -2.1% | (− 11.5,7.3) | − 11.1% | (− 25.5,3.3) | 84.9% | − 13.1% | 0.046 |
Total cost for most recent illness (all HHs) | −1.77 | (− 3.2,-0.4) | − 0.05 | (− 1.1,1.0) | −1.71 | (− 3.5,0.0) | −1.95 | (− 3.4,-0.5) | − 0.28 | (−1.5,0.9) | − 1.67 | (− 3.5,0.2) | 1.49 | − 111.7% | 0.059 |
Most Recent Adult Chronic Illness Visit | |||||||||||||||
Health Facility Payments for OP Cared | |||||||||||||||
Any payment for OP care at facility | 5.0% | (−10.8,20.9) | 10.6% | (−1.9,23.1) | −5.6% | (− 25.8,14.6) | − 1.5% | (− 19.2,16.3) | 7.2% | (− 8.2,22.6) | − 8.7% | (− 33.2,15.9) | 77.5% | −11.2% | 0.073 |
Total paid at facility for visit (all HHs) | 0.57 | (−1.4,2.6) | 1.32 | (− 0.3,3.0) | − 0.74 | (−3.3,1.9) | − 0.10 | (− 2.4,2.2) | 0.69 | (− 1.2,2.5) | − 0.78 | (− 3.8,2.3) | 0.51 | − 154.2% | 0.084 |
Average Monthly Medication Costs | |||||||||||||||
Any regular (monthly) medication costs | 4.9% | (− 17.2,27.1) | 5.1% | (−7.5,17.8) | −0.2% | (− 25.7,25.3) | 5.2% | (− 19.1,29.4) | − 0.8% | (− 15.0,13.3) | 6.0% | (−22.3,34.3) | 71.6% | 8.4% | 0.077 |
Average monthly medication costs (all cases) | 0.43 | (−2.5,3.4) | 0.61 | (−1.0,2.2) | −0.18 | (−3.5,3.2) | 0.32 | (−2.9,3.5) | −0.02 | (−1.8,1.8) | 0.33 | (−3.4,4.0) | −0.07 | − 449.8% | 0.086 |
Routine Spending on Health | |||||||||||||||
Health expenditures (past month)f | 0.70 | (−0.2,1.6) | 1.49 | (0.8,2.2) | −0.79 | (−1.9,0.3) | 0.24 | (−0.7,1.2) | 0.53 | (−0.2,1.3) | −0.30 | (−1.5,0.9) | 2.01 | −14.7% | 0.131 |
Sold assets to pay for health (past 3 mos) | 2.5% | (−1.5,6.5) | 7.0% | (3.6,10.3) | −4.5% | (−9.7,0.7) | 2.0% | (−2.4,6.4) | 4.0% | (0.4,7.7) | −2.0% | (−7.9,3.8) | 6.8% | −29.7% | 0.044 |
Borrowed to pay for health (past 3 mos) | 42.4% | (32.8,52.0) | 34.9% | (29.0,40.8) | 7.5% | (−3.8,18.7) | 38.0% | (27.7,48.3) | 32.6% | (25.8,39.4) | 5.4% | (−6.6,17.3) | 37.3% | 14.4% | 0.218 |