Integrated Safety Nets Transform Child Outcomes Where Cash Alone Falls Short

An integrated social safety net in rural Burkina Faso showed that cash alone produced few lasting benefits, while cash combined with information and home visits led to durable improvements in fertility decisions, health behaviors, schooling, and children’s prosocial development. The study highlights that personalized home visits—not money or information alone—were the critical driver of sustained change.

A major multi-institution collaboration, led by the University of Illinois at Urbana-Champaign, the World Bank’s Development Research Group, Oklahoma State University, and the College of William & Mary, set out to answer a fundamental development question: What combination of social protection tools genuinely improves children’s lives in one of the poorest regions of Burkina Faso? Their study, “Medium-Term Impacts of Integrated Social Safety Nets,” evaluates whether unconditional cash transfers are enough or whether layered behavioral interventions such as information meetings and home visits are essential to produce lasting benefits. Conducted across 225 rural villages, the experiment unfolded in communities marked by chronic food insecurity, low school participation, and deteriorating security conditions.

Cash Alone Didn’t Move the Needle, but Home Visits Did

The program’s structure allowed researchers to separate the effects of cash, information, and home visits. Some villages received cash only, some received cash plus group information sessions, and others received cash, information, and twice-monthly home visits by trained government social workers. Cash was delivered quarterly beginning in 2018, while information and home visits started in 2019. The evaluation became even more revealing when insecurity forced the 2021 endline survey to be delayed by 15 months. The result was a rare medium-term perspective showing what remains after programs stop.

What remained was decisive: only the villages receiving the full package, cash, information, and home visits, showed meaningful, sustained improvements. Cash alone, and cash plus information meetings, produced little lasting change in parental behaviors or child outcomes. Home visits were the only component that translated resources and knowledge into durable action.

Transformations in Maternal Health and Child Well-Being

Women in the full-treatment villages experienced fewer pregnancies and longer spacing between births, and they were substantially more likely to have had their most recent childbirth attended by a medical professional. Mothers also reported more prenatal visits and improved hygiene habits, washing hands after using the toilet and before meals, at higher rates than in any other group. In children, gains appeared across several health indicators: increased use of mosquito nets, more diverse diets, more frequent vitamin A supplementation, and fewer episodes of diarrhea, one of the most common childhood illnesses in low-income settings.

These results closely mirrored the curriculum delivered during home visits, suggesting that personalized reinforcement, not information alone, drove behavioral change. Anthropometric improvements were modest overall, aside from gains in arm circumference, consistent with evidence that nutrition indicators shift slowly unless programs run for many years.

Education Gains and Early Childhood Development Outcomes

Educational outcomes told a promising story. Children in full-treatment households were more likely to be enrolled in school, further along in their expected grade progression, and had completed more years of schooling. Interestingly, cash-only households posted similar educational gains, underscoring that financial constraints, not parental knowledge, are often the biggest barrier to schooling in impoverished rural communities.

In early childhood development, the results were mixed. Standardized Denver assessments showed no broad or lasting improvements, but the Strengths and Difficulties Questionnaire revealed notable gains in children’s prosocial behavior, traits like sharing and helping others. Researchers argue this reflects deeper shifts in parent-child interactions fostered by home visits, which provided a relational form of coaching that group meetings alone could not replicate.

Why Home Visits Worked, and Why They Matter for Policy

The study identifies several reasons why home visits succeeded where other components fell short. They built trust, especially in villages unaccustomed to sustained government presence. They allowed social workers to clarify, personalize, and repeat key messages. And they created accountability, as families knew someone would return to track progress. Even though insecurity limited the endline sample to 74 villages, the authors conducted extensive tests confirming that attrition did not bias results. Program monitoring further showed high implementation fidelity, particularly in the earlier phases.

Cost-effectiveness calculations reinforced the central insight: while information sessions added little value, home visits, though slightly more expensive, generated the highest returns across health, fertility, education, and socio-emotional development. The overarching conclusion is clear: cash reduces poverty, but it is the human connection that changes behavior. When financial support is combined with personalized guidance, families are better able to invest in their children’s futures, and the effects endure well beyond the life of the program.