Evaluation of a cash-plus programme for children with disabilities in Laos
| ISRCTN | ISRCTN80603476 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN80603476 |
- Submission date
- 25/09/2023
- Registration date
- 16/10/2023
- Last edited
- 14/05/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
It is estimated that 15% of the global population is living with a disability. Amongst children, 1 in 20 have a disability. Disability and poverty are linked in a causal and consequential relationship. Persons with disabilities often experience considerably higher rates of poverty and socioeconomic disadvantage compared to people without disabilities. Social protection is an important tool for reducing poverty and marginalisation, including amongst people with disabilities and their families. Many countries have recognised the need for and right to social protection amongst people with disabilities, with over 170 countries implementing disability-targeted social assistance programmes. However, there is a lack of evidence on the impact of social protection on people with disabilities. Additionally, there is an increasing recognition that cash transfers are an important but insufficient tool to push people out of poverty and improve their well-being. Cash transfers alone may be insufficient for people with disabilities due to the poor availability, quality, accessibility and affordability of needed goods and services. As such, there is an increasing focus on developing integrated social protection or “cash plus” programmes. Cash plus programmes provide recipients with both a cash transfer as well as complementary programmes, such as health insurance and linkages to key services. This study will undertake an evaluation of a cash plus programme delivered to children with disabilities in Lao PDR by UNICEF.
Who can participate?
Children aged up to 18 years old with disabilities and households in Pek, Khoun, Phokoud districts (intervention) and Nonghed, Kham districts (control) in Xiengkhouang Province, Lao PDR.
What does this study involve?
This research involves an impact (non-randomised controlled trial) and process evaluation, including qualitative research.
Non-randomised controlled trial
1. Approximately 450 children with disabilities eligible for the cash plus programme have been recruited. Children in the Pek, Khoun and Phokoud districts will receive the intervention, and children in the Nonghed and Kham districts will be the control.
2. Baseline survey conducted in 2023, with endline two years after
3. Outcomes compared between groups include multidimensional child poverty, caregiver well-being and household poverty
Process evaluation
1. Approximately 25-40 interviews will be conducted with caregivers of children with disabilities throughout the project. Questions will focus on their experience with and opinions of the cash-plus programme. 15-20 key implementers of the cash-plus programme will also be interviewed about their experience designing or delivering different components of the programme, and/or their opinions about the programme.
What are the possible benefits and risks of participating?
Participants benefit from remuneration for their time participating in the study. The information gathered from the study can help improve social protection programmes for this population in the future. Please note, that as this is an observational intervention, LSHTM does not have oversight or liability for the running of the intervention. The programme implementers will have their separate monitoring, response and insurance systems for any harm resulting from participation in the cash plus programme.
The risk of discomfort, distress and any other hazards as a result of participating in this research is considered low. Participants will be asked questions, most of which are not on sensitive topics. Still, some participants may experience discomfort as a result of discussing potentially distressing experiences.
Where is the study run from?
The study is run by the International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine and the National Institute of Public Health in Lao PDR
When is the study starting and how long is it expected to run?
January 2023 to September 2025
Who is funding the study?
UK Foreign Commonwealth and Development Office (FCDO)
Who is the main contact?
Dr Morgon Banks, morgon.banks@lshtm.ac.uk
Contact information
Principal Investigator
London School of Hygiene & Tropical Medicine
Keppel St
London
WC1E 7HT
United Kingdom
 ORCID ID |
0000-0002-4585-1103 |
|---|---|
| Phone | +44 (0)20 7636 8636 |
| morgon.banks@lshtm.ac.uk |
Scientific
London School of Hygiene & Tropical Medicine
Keppel St
London
WC1E 7HT
United Kingdom
| Phone | +44 (0)20 7636 8636 |
|---|---|
| morgon.banks@lshtm.ac.uk |
Public
London School of Hygiene & Tropical Medicine
Keppel St
London
WC1E 7HT
United Kingdom
| Phone | +44 (0)20 7636 8636 |
|---|---|
| morgon.banks@lshtm.ac.uk |
Study information
| Study design | Observational non-randomized controlled study with complimentary qualitative research |
|---|---|
| Primary study design | Observational |
| Secondary study design | Non-randomised controlled trial |
| Study setting(s) | Community |
| Study type | Other |
| Participant information sheet | 44317_PIS_V1.0_30Sept2022.pdf |
| Scientific title | Impact evaluation of the pilot cash transfer programme children with disabilities in Xiengkhouang Province, Lao PDR: a non-randomised controlled trial and process evaluation |
| Study objectives | The overall aim of this research is to assess the impact of a UNICEF cash-plus programme for children with disabilities and their households in the Lao People's Democratic Republic (Lao PDR). The objectives are: 1. To evaluate the impact of a cash-plus programme on multidimensional poverty among children with disabilities 2. To assess the impact of a cash-plus programme on caregivers’ well-being 3. To measure the impact of a cash-plus programme on household poverty 4. To estimate the impact of a cash-plus programme on unmet needs for and out-of-pocket spending on disability-related “extra costs” 5. To explore the perceived impact of and satisfaction with the cash-plus programme amongst children with disabilities and their caregivers 6. To examine challenges and enablers to the implementation and delivery of the cash-plus programme from the perspective of children/caregivers and implementers |
| Ethics approval(s) |
1. Approved 12/04/2023, London School of Hygiene & Tropical Medicine Research Ethics Committee (Keppel St, London, WC1E 7HT, United Kingdom; +44 (0)20 7927 2221; Ethics@lshtm.ac.uk), ref: 28234 2. Approved 27/02/2023, Lao PDR Ministry of Health National Ethics Committee for Health Research (National Ethics Committee for Health Research, Vientiane, None available, Lao People's Democratic Republic; +856 21 250 670; nechr2021@gmail.com), ref: 13/NECHR |
| Health condition(s) or problem(s) studied | Multidimensional child poverty, caregiver well-being and household poverty amongst children with disabilities and households in Lao PDR |
| Intervention | The intervention, delivered by UNICEF, with support from the Lao PDR government, will include a cash-transfer, family training/support and an assessment for assistive technology needs. 1. The cash-transfer will be paid monthly to households of a child with a disability. 2. Family training and support will provide caregivers and family members with information on disability, supporting children at home and in the community, and on financial management. 3. Children found to have an unmet need for assistive technology will be provided with devices free of charge. This is a pilot intervention, being delivered by UNICEF in Pek, Khoun and Phou Khoud districts of Xiengkhouang Province. Nonghed and Kham districts of Xiengkhouang Province were selected as control districts, where children with disabilities would be eligible for the programme. The evaluation research involves an impact and process evaluation, via a non-randomised controlled trial and complimentary process evaluation, including qualitative research. Non-randomised controlled trial: 1. UNICEF identified eligible children with disabilities in Pek, Khoun, Phou Khoud, Nonghed, and Kham districts to identify children eligible to receive the programme. Children in the Khoun, Phokoud and Pek districts will be part of the intervention and children in the Nonghead and Kham districts will be part of the control. 2. Baseline survey conducted with approximely 450 participants. Endline survey will be completed 2 years after baseline. 3. Data will be analysed as intention to treat. Primary outcome is multidimensional child poverty. Secondary outcomes are caregiver well-being, household poverty and out-of-pocket spending on disability-related extra costs Process evaluation 1. Approximately 25-40 interviews will be conducted with caregivers of children with disabilities throughout the project. Questions will focus on their experience with and opinions of the cash-plus programme. 15-20 key implementers of the cash-plus programme will also be interviewed about their experience designing or delivering different components of the programme, and/or their opinions about the programme. |
| Intervention type | Mixed |
| Primary outcome measure | The primary outcome measure will be assessed at baseline and endline. Multidimensional child poverty measured using multidimensional poverty indices (MPIs) and multidimensional overlapping deprivation analysis (MODA), collating several variables of deprivation. Variables include education and early child development, health, food security, social participation, WASH and violence. Each indicator will be assigned a weight (e.g. equal weights for each domain, with any sub-domain measures equally weighted to the domain total) such that the total of the index falls between 0 to 1 (0 being the child experiences no deprivation on any indicator, 1 being child experiences deprivation across all indicators). |
| Secondary outcome measures | All secondary outcome measures will be assessed at baseline and endline. 1. Household financial well-being (e.g., change in per capita household expenditures, poverty measured by comparing expenditure (food and non-food) and household assets against the national poverty line 2. Caregiver well-being measured using the Pediatric Quality of Life (PedsQL) Family Impact module 3. Unmet need for and out-of-pocket spending on different disability-related extra costs measured by caregiver-reported need for and use of different goods and services required to support their child’s participation (e.g. healthcare, assistive devices, inclusive education supports, additional transport, personal assistance) |
| Overall study start date | 01/11/2022 |
| Completion date | 30/09/2025 |
Eligibility
| Participant type(s) | Healthy volunteer, Service user |
|---|---|
| Age group | Child |
| Lower age limit | 0 Years |
| Upper age limit | 18 Years |
| Sex | Both |
| Target number of participants | 450 |
| Key inclusion criteria | Eligibility for the cash-plus programme for participants in both the control and intervention arms is based on the following: 1. Has a disability 2. Aged under 18 years old 3. Live in target districts (Pek, Phokoud, Khoun, Kham, Nonghed) |
| Key exclusion criteria | 1. Aged over 18 years old 2. Without a disability |
| Date of first enrolment | 01/05/2023 |
| Date of final enrolment | 31/10/2023 |
Locations
Countries of recruitment
- England
- Lao People's Democratic Republic
- United Kingdom
Study participating centres
London
WC1E 7HT
United Kingdom
Ban Kaognot
Sisattanack district
Vientiane Capital
None available
Lao People's Democratic Republic
Sponsor information
University/education
Keppel St
London
WC1E 7HT
England
United Kingdom
| Phone | +44 (0)20 7636 8636 |
|---|---|
| disabilitycentre@lshtm.ac.uk | |
| Website | http://www.lshtm.ac.uk/ |
"ROR" |
https://ror.org/00a0jsq62 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- Foreign, Commonwealth & Development Office, Foreign, Commonwealth & Development Office, UK Government, FCDO
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/12/2025 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not expected to be made available |
| Publication and dissemination plan | Planned publication in a high-impact peer-reviewed journal |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are not expected to be made available because the researchers do not think that these data can be adequately anonymised. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Participant information sheet | version 1.0 | 30/09/2022 | 27/09/2023 | No | Yes |
| Protocol article | 13/05/2024 | 14/05/2024 | Yes | No |
Additional files
Editorial Notes
14/05/2024: Publication reference added.
27/09/2023: Study's existence confirmed by the London School of Hygiene & Tropical Medicine Research Ethics Committee (UK).
