Assessing the Impact of U.S. Food Assistance Delivery Policies on Child Mortality in Northern Kenya

Abstract

The U.S. is the main country in the world that delivers its food assistance primarily via transoceanic shipments of commodity-based in-kind food. This approach is costlier and less timely than cash-based assistance, which includes cash transfers, food vouchers, and local and regional procurement, where food is bought in or nearby the recipient country. The U.S.’s approach is exacerbated by a requirement that half of its transoceanic food shipments need to be sent on U.S.-flag vessels. We estimate the effect of these U.S. food assistance distribution policies on child mortality in northern Kenya by formulating and optimizing a supply chain model. In our model, monthly orders of transoceanic shipments and cash-based interventions are chosen to minimize child mortality subject to an annual budget constraint and to policy constraints on the allowable proportions of cash-based interventions and non-US-flag shipments. By varying the restrictiveness of these policy constraints, we assess the impact of possible changes in U.S. food aid policies on child mortality. The model includes an existing regression model that uses household survey data and geospatial data to forecast the mean mid-upper-arm circumference Z scores among children in a community, and allows food assistance to increase Z scores, and Z scores to influence mortality rates. We find that cash-based interventions are a much more powerful policy lever than the U.S.-flag vessel requirement: switching to cash-based interventions reduces child mortality from 4.4% to 3.7% (a 16.2% relative reduction) in our model, whereas eliminating the U.S.-flag vessel restriction without increasing the use of cash-based interventions generates a relative reduction in child mortality of only 1.1%. The great majority of the gains achieved by cash-based interventions are due to their reduced cost, not their reduced delivery lead times; i.e., the reduction of shipping expenses allows for more food to be delivered, which reduces child mortality.

Cash and voucher assistance along humanitarian supply chains: a literature review and directions for future research

“…CVA is either conditional or unconditional to cover the procurement of a diverse range of goods and services, notably, food/non‐food items (Sabates‐Wheeler and Devereux, 2010 ), water, sanitation, and hygiene (see, for example, Enshassi et al, 2017 ; Heaslip, Kavas, and Haavisto, 2018a ; Martin‐Simpson, Parkinson, and Katsou, 2018 ), medical products (Nikulkov et al, 2016 ), and shelter and housing materials (Matopoulos, Kavas, and Hayes, 2014 ). Unconditional CVA provides beneficiaries and local market operators with greater flexibility (Burkart, Besiou, and Wakolbinger, 2016 ; Heaslip, Kavas, and Haavisto, 2018b ) and can be used to cover multiple needs simultaneously (Sabates‐Wheeler and Devereux, 2010 ; Tappis and Doocy, 2018 ).…”

On design-based empirical research and its interpretation and ethics in sustainability science

“…But the humanitarian response community strongly favors using the imperfect knowledge they possess about what works best to save lives, relieve suffering, and defend human dignity in the face of anthropogenic or natural disasters without relegating some subjects to a control group designed to be deprived of disaster relief. Rather, researchers rely on natural experiments and careful inference using observational data or contextualized structural models to draw defensible causal inferences as to what works best in humanitarian response (61)(62)(63). Power imbalances too often let well-financed foreign researchers with high-level connections run roughshod over the legitimate, competing aspirations of subject communities.…”