Post-intervention gendered impacts and moderating factors of a government cash plus intervention for adolescents in Tanzania.
Outcomes: Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Gender norms play a critical moderating role in shaping the effectiveness of multisectoral “cash plus” interventions for adolescents. While the intervention aimed to improve livelihoods, health, and empowerment outcomes, entrenched gender norms—particularly around contraception, relationships, and service use—limited sustained behavior change. Norms influenced both access to and uptake of services, and in some cases undermined intervention impacts (e.g., reduced contraceptive use in more conservative communities). The findings underscore that interventions targeting adolescents alone may be insufficient to shift deeply embedded norms; broader, community-level and structural approaches are needed to achieve durable change in gendered behaviors and outcomes.
Objectives The study aimed to assess the 22-month post-intervention impacts of a government-implemented “cash plus” intervention (Ujana Salama) on adolescents’ social, health, and economic outcomes, and to examine how contextual factors—particularly gender norms and health service quality—moderate these impacts.
Methods A longitudinal cluster randomized controlled trial (cRCT) was conducted among adolescents aged 14–19 years in Tanzania. The intervention combined cash transfers with complementary components, including life skills and livelihoods training, mentoring, productive grants, and linkages to adolescent-friendly health services. Quantitative surveys were administered at baseline and multiple follow-ups (including 22 months post-intervention), and impacts were estimated using intent-to-treat and ANCOVA models. Social norms were measured as community-level injunctive norms (perceived expectations) collected via community surveys, and analyzed as moderating variables alongside health service readiness indicators.
Results Post-intervention impacts were limited and mixed. Protective effects included reduced lifetime sexual violence among females and increased sexual and reproductive health (SRH) service use among males. However, many earlier gains (e.g., HIV knowledge, gender-equitable attitudes, contraceptive knowledge) were not sustained. New adverse outcomes emerged, including increased depressive symptoms. Gender norms significantly moderated outcomes: in more conservative communities, the intervention reduced contraceptive use, while in contexts with poorer health service quality, some positive effects (e.g., increased service use) were more pronounced. Overall, impacts on complex, relational outcomes—such as gender attitudes, sexual behavior, and violence—were weak or inconsistent.
Conclusions The study concludes that while cash plus interventions can generate short-term improvements, sustained and transformative change—particularly in gendered and relational domains—requires longer-term, multi-level approaches that directly address social norms and structural constraints. Programs should move beyond individual-level interventions to engage communities and systems, especially where gender norms are deeply entrenched. External shocks (e.g., payment delays, COVID-19) further highlight the vulnerability of intervention impacts, reinforcing the need for more resilient and comprehensive program designs.
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