Association for Public Policy Analysis & Management

In sub-Saharan Africa, government social programs provide little support to children living in poverty. AIDS-impacted children (those who have lost one or both parents to AIDS) face further disadvantage and unequal chances to thrive in lives. Effective and efficient social programs and policies are urgently needed to ensure healthy development and educational opportunities for these children. This study examines whether an asset-based social protection program that specifically focuses on savings accounts for children education and family small business development may be a viable approach to improving educational and health and mental health outcomes among AIDS-impacted children and eliminate inequality in opportunities. Furthermore, cost-effectiveness of varying intervention strategies will be examined to help guide the assessment of feasibility for scale-up.

The Bridges to the Future is a United States National Institute of Child Health and Development (NICHD) funded study. The study recruited children in grade 5 or 6 from 48 randomly selected primary schools in southwest districts of Uganda. In total, 1,410 students met the study inclusion criteria and were recruited in 2012. The 48 schools were randomly assigned to three study arms: 1) Usual Care (n=496); 2) Bridges (n=402); and 3) Bridges PLUS (n=512). Children in all the three study arms received usual care for AIDS-impacted children in the study area, consisting of counseling, school lunches and scholastic materials. Each child in each of the two treatment arms: Bridges and Bridges PLUS received the usual care intervention plus a Child Development Account; a 12-session of workshop on asset-building and future planning; regular mentorship meetings with undergraduate students; and income-generating activity training. Bridges and Bridges PLUS had varying financial incentives for participants to save. Bridges PLUS participants received a 1:2 match-rate while Bridges participants received a 1:1 match-rate. The intervention was provided for 24 months. This study examines the effectiveness and cost-effectiveness during the two intervention years.

The main outcomes of this study include health and educational wellbeing. Health indicators include self-rated physical health and mental health (measured by Child Depression Inventory and Beck’s Hopeless Scale). Educational outcomes include school attendance rates, school completion rates, and exam performance. The data were either administrative data from the school or collected through in-person interviews. We examine the health and educational outcomes using multilevel models to adjust for clustering at the school levels. Further, we conduct a cost-effectiveness analysis, examining how much Bridges or Bridges PLUS costs to achieve an impact. We first describe the cost composition by program activities and calculate the per person program cost. We then divide per-person costs of Bridges and Bridges PLUS by the relevant effects to produce cost-effectiveness ratios. We particularly compare cost-effectiveness of offering additional savings incentives (a higher savings match-rate) on improving health and educational wellbeing. Preliminary findings show that the intervention had positive impacts on both health and educational wellbeing of AIDS-impacted children. The Bridges PLUS, compared to the Bridges, is more cost-effective in some outcomes. Findings from this study have implications for interventions and policies in low-income countries aiming to address child poverty issues.