A Cash Plus Pilot in Tanzania to Facilitate Safe Transitions to Adulthoodusaj

Dr. Lusajo Kajula spent nearly 16 years working as a lecturer at the Muhimbili University of Health and Allied Sciences (MUHAS) and a psychologist at Muhimbili National Hospital (MNH), the national referral hospital as well as the teaching facility for MUHAS, in Dar es Salaam, Tanzania. In her role at MUHAS, Dr. Kajula was involved in multiple international research collaborations that addressed adolescent and youth sexual health and behavior in sub-Saharan Africa. At MUHAS, she was also part of the team that established Tanzania’s first master’s program in clinical psychology.

Having spent over a decade at Muhimbili, Dr. Kajula led a happy, busy life. But, when two friends sent her an application for the same job with the United Nations Children Fund (UNICEF) to coordinate a study to understand how cash transfers impact adolescent sexual health and wellbeing in Tanzania, Dr. Kajula was interested. The opportunity aligned with her training and expertise, and she felt that it was time for a change.

Dr. Kajula grew up in Dar es Salaam, the largest city and commercial capital of Tanzania. Growing up she wanted to be a radio broadcaster, however her father encouraged and challenged her to look into other fields. He pushed her to become an economist; but, although she studied economics in high school, she didn’t enjoy it as much as she had enjoyed studying science in secondary school.

Dr. Lusajo was eager for the opportunity to get her bachelor’s degree at the Aligarh University in Uttar Pradesh, India. She registered for a program in psychology, despite not being familiar with the field. Thankfully, she enjoyed it so much that she received her bachelors in psychology with a first class, or the highest honors, and began to take steps to pursue a master’s degree. Initially, Dr. Kajula applied to a clinical psychology program in Manchester, UK, where her mother was studying for her master’s at the time, but the program only accepted students from Europe and she left for home extremely disappointed.

It was at this time that Dr. Lusajo started her first job at Muhimbili. For two years she worked as a research assistant. She nurtured a partnership with Suzanne Maman, now professor of health behavior at the UNC Gillings School of Global Health, who at the time was working toward her PhD at Johns Hopkins University. This partnership and friendship has spanned the years and resulted in several funded proposals.

The delay in her academic career did not deter Dr. Kajula. Her work and continued interest in clinical psychology and health behavior informed her master’s degree and Ph.D., which she received in Health Behavior and Promotion from the University of Bergen, Norway and Maastricht University, the Netherlands. Her Ph.D. dissertation titled “Adolescent sexual health communication with parents and peers and the associated parenting practices in Dar es Salaam Tanzania” describes parenting practices associated with adolescent sexual health and parent and peer health communication.

It was in 2017, that Dr. Kajula met Dr. Tia Palermo, then Social Policy Manager with the UNICEF Office of Research-Innocenti, and now Associate Professor with the Department of Epidemiology and Environmental Health at UB. Dr. Palermo interviewed Dr. Lusajo and offered her the job. Within a year, Dr. Kajula’s contract was extended and she has never looked back.

Dr. Kajula coordinates a research study examining impacts of a government-implemented (with technical support from UNICEF) pilot project that aims to increase sexual health protective behaviors and livelihood opportunities among adolescents. Project interventions focus on sexual health, mental health, gender and livelihood. Participants learn about sexual protection, for example, how to delay in engaging in sex, and availability of youth friendly services in government health facilities. To reduce violence in relationships, participants discuss perpetration and victimization, and how to protect themselves from violence. The program is referred to as a “cash plus” program because it revolves around a social protection program whose main component includes cash transfers targeted to poor households and is implemented by the government agency, Tanzania Social Action Fund (TASAF).

The research study, which was set to end in but has been extended to 2021 due to COVID-19, is currently being conducted in 4 rural districts within 2 regions in the southern highlands of Tanzania. One district, Mufindi, is the second richest district in all of Tanzania; the main economic gains come from tree harvesting. This business has enriched the owners of the harvesting companies which are mostly external to the community, however community members work for daily wages to harvest trees. The main road that runs through this economic hub to Malawi and Zambia, has increased the risk to young girls who engage in transactional sex.

It is for this reason that cash plus is an important opportunity for adolescents from poor households. Many must find work to help support their family. If they can gain skills in creating and supporting a business, they can better care for themselves and have an increased chance of participating in income generating activities.

Within the cash plus program, program administrators work with a cohort of adolescents between 14 and 19 years of age. The program comprises livelihoods and life skills training, mentoring and a productive grant, and linkages to adolescent-friendly sexual and reproductive health services. Adolescents learn livelihood skills that teach them how to create a business, sell, invest, and save. Adolescents are encouraged to link up with mentors who can act as experts and guides.  According to Dr. Kajula, the adolescent participants are smart and savvy. For example, some participants who received funds for transportation will often find other means of transportation and save and invest that money, mostly by buying livestock that they ask their parents to maintain when they are in school. Parents have also been supportive of the program. Secondary school which is free in Tanzania, includes added costs that concern parents. In poorer families, the non-fee costs of buying books, uniforms, shoes, sweaters, etc. reduces a child’s likelihood of completing secondary school. With additional income and training, adolescents are enlisting their newly learned livelihood skills toward economic development and improved health and wellbeing.

As we near the end of a tumultuous 2020, Dr. Kajula is eager to evaluate and learn from this program. Of surprise to the researchers, by midline the young men in the program tended to have more gender equitable attitudes than the women. The team is eager to see whether these impacts will be sustained by the end of the evaluation; their hope is that this attitude leads to a reduction in the perpetuation of violence against women.