Research on Food Assistance for Nutritional Impact (REFANI): Literature Review

Evidence on the use of Cash Transfer Programmes, and the impact they have on acute malnutrition in humanitarian contexts


Globally, between 2010 and 2012, 18 to 20 billion US$ was spent each year on humanitarian response, and expenditure on emergency food assistance has remained a major component. While most expenditure has been in the form of direct food transfers, an increasing proportion has been through cash and voucher transfers. However, there remain significant gaps in evidence regarding the impact of these emerging food assistance interventions on the prevention of acute malnutrition in emergencies. For this reason, Action Against Hunger | ACF International, Concern Worldwide, the Emergency Nutrition Network (ENN) and University College of London (UCL) have come together in a consortium to undertake applied research on this topic.

With support from the Department for International Development (DFID/UKAID), REFANI examines the impact of cash and voucher-based food assistance on nutrition outcomes with the aim of creating an evidence base for high-impact and cost-effective mechanisms in the prevention of acute under-nutrition in emergencies.

The REFANI literature review identifies existing evidence on the use of Cash Transfer Programmes (CTPs) and the impact of CTPs on acute malnutrition in humanitarian contexts. The review is structured as follows:

  • Section A discusses the global burden of acute malnutrition;

  • Section B highlights traditional food-based interventions;

  • Section C explores cash-based interventions and the emergence of CTPs within humanitarian programmes; and finally,

  • Section D explores the existing evidence from CTP interventions

Importantly, the REFANI literature review identifies key gaps that remain in our collective knowledge base. In particular, the review finds that, although complicated given that the impact pathways of CTPs are numerous and context-specific, a greater understanding of how (i.e. the mechanisms through which) these transfers work is necessary. More evidence is also needed on a range of CTP design features (e.g. timing, duration, amount and frequency), modalities (e.g. cash or vouchers), and recipient targeting criteria. Finally, very little is known about the sustainability of such programmes and their cost-effectiveness, especially over the course of the post-intervention period.


Fenn, B. Research on Food Assistance for Nutritional Impact (REFANI): Literature Review. Action Against Hunger, New York, NY, USA (2015) 35 pp.

Research on Food Assistance for Nutritional Impact (REFANI): Literature Review

Published 1 January 2015