The Impact of Administrative Burdens in Ghana’s LEAP Cash Transfer Programme: Insights for Enhancing Well-being

Abstract

This article reports experiences and challenges connected with Ghana’s Livelihood Empowerment Against Poverty (LEAP) programme and its implications for grant access and impacts on recipients’ well-being. Engaging with the administrative burden’s framework, we find that inadequate information; transport, timing and financial barriers to accessing payments; irregularity of payments; electronic payment difficulties; gift giving to programme administrators; and lack of access to complementary services are the key administrative challenges watering down the LEAP impacts on recipients’ well-being. We recommend establishing an appropriate information delivery system, feedback and monitoring mechanisms, providing other productivity-enhancing services to complement the LEAP grant, strengthening the local implementation structures and payment procedures and reducing travel costs and waiting time for service delivery.

The key objective of this article is to examine micro-level administration burdens of social cash transfers (SCTs) and their consequent impacts on beneficiaries’ well-being. It does so by reporting findings from a study of Ghana’s Livelihood Empowerment Against Poverty (LEAP) programme. Case study narratives were obtained from 15 recipients and caregivers through semi-structured, in-depth interviews (part of a larger mixed-method study). The findings highlight the practical everyday administrative challenges programme recipients face in participating in cash transfer programmes. This article contributes to the knowledge and practice of micro-level administrative burden consequences affecting SCT programme recipients and improving implementation systems to enhance well-being of receipts, particularly in sub-Saharan Africa.

SCTs are commonly defined as predictable and reliable non-contributory financial benefits typically financed by the state for the protection, promotion, prevention and transformation of vulnerable and poorer populations (Kidd, 2016; Kidd & Athias, 2019). SCTs were spearheaded in Latin America and subsequently proliferated in African countries, especially in sub-Saharan Africa. The implementation of SCT programmes has been accompanied by robust, large-scale, quantitative evaluations, generating valuable knowledge across key programme features, from choice of payment mode to identification and targeting of potential recipients, to payment or delivery mechanisms and assessment of programme impacts.

What is more challenging, however, is to find complementary research that examines the implications of SCT administrative processes and practices that may create burdens and unintended but related social consequences. Compared with programmes offering universal benefits, means-tested transfer programmes that target poorer populations by their design are more complex in their forms and procedures, with rules embodied in formal application requirements, which impede benefits take-up (Moynihan et al., 2016). Administrative burdens associated with means-tested cash transfer programmes include excessively complex procedures, delays in processing benefit claims, inadequate education about programme rules and requirements, or the procedural costs of applying for benefits. These include the transaction costs of compiling required documents and other information, travel cost and completing forms, tests or other requirements of the process (Bhargava & Manoli, 2012; Herd et al., 2013; Tabor, 2002). There are also psychological costs associated with intrusiveness of application demands and rejection and stigma that might be experienced in the process (Herd et al., 2013; Moynihan et al., 2016).

Studies on SCT programmes in both developed and developing countries have focused on assessing implications of SCT administrative burdens among legitimate claimants’ take up of benefits or services, targeting effectiveness or constraints to accessing benefits (e.g., reducing programme take-up) or how changes in programme rules and requirements to reduce burdens may increase programme access (Álvarez et al., 2008; Handa et al., 2012; Tabor, 2002; Zembe-Mkabile et al., 2012). We argue that consideration of overlooked elements such as how administrative burdens in the operation of SCTs create negative well-being consequences, alongside reduced benefit take-up and access, allows for enhanced understanding of the impact and effectiveness of SCTs being deployed in developing countries.

This article is organised into six sections. Following this introduction, the next section provides an overview of Ghana’s LEAP programme. The subsequent two sections review the study’s underpinning theoretical framework and literature on micro-level administrative burdens of cash transfers. Section five outlines the research design and data, and section six reports the findings from participants’ interviews, followed by discussions and the conclusion.

Ghana’s LEAP Programme

Ghana’s LEAP programme was introduced in 2008 as a flagship social protection intervention. It was designed to provide a safety net for the poorest 20% of Ghana’s population, covering families with either elderly individuals (age 65 and above), unemployable disabled people, or Orphans and Vulnerable Children (OVC). The premise for its introduction was the fact that cash transfers have a direct impact on poverty and help poor and vulnerable groups to deal with poverty and associated risks (Adjei et al., 2012; DFID, 2005). The programme seeks to provide predictable and reliable cash payments and complementary services (e.g., health benefits) to vulnerable individuals and households to improve their livelihoods while protecting and mitigating the adverse impacts of poverty.

The LEAP programme is coordinated by the Ministry of Gender, Children and Social Protection and administered by the Department of Social Welfare LEAP Management Unit. Implementation at local levels is supported by District and Community LEAP Implementation Committees (D/CLICs) or focal person(s) nominated to assist implementation within communities.

While the LEAP grant is unconditional for the household with a member who has disability and the aged household (over 65 years) beneficiaries, ¹ carers of OVC must adhere to certain behavioural requirements, including sending school-age children to school, birth registration of newborn babies, attendance at post-natal clinics, full vaccination of children up to the age of five, non-trafficking of children and non-involvement in the worst forms of child labour (Government of Ghana, 2018).

The programme is largely financed by the Government of Ghana general budget revenue with assistance from the World Bank. In mid-2023, the LEAP covered 147,881 beneficiary households in 187 of the country’s 234 districts, across all 16 regions of Ghana. This compares with an estimated 2.4 million (an estimated 380,000 households) extremely poor people in Ghana in 2016–2017 (Government of Ghana 2018).

The LEAP grant is paid bimonthly to households. The amount is determined by the number of eligible vulnerable people (aged, orphan and vulnerable children, disabled) in the household. Currently, for one LEAP-eligible person in the household, the household receives GH¢ 128 (US$ 11.60), two receive GH¢ 144 (US$ 13.09), three receive GH¢ 176 (US$ 16) and GH¢ 212 (US$ 19.30) ² is paid for four or more. These payment levels represent at least 18.3% of the average food expenditure of eligible households (Angeles et al., 2017). Beneficiaries are also linked to other social protection initiatives and provided with complementary services including free enrolment into the National Health Insurance Scheme (NHIS).

Conceptualising Administrative Burdens

This study is underpinned by the administrative burden framework advanced by Herd and Moynihan (2018). They define administrative burdens as ‘the learning, psychological, and compliance costs that citizens experience in their interactions with government’ (p. 32). Three types of costs to beneficiaries of public services emanating from administrative burdens are identified. The first is the cost associated with the process of seeking information about the programme in terms of what, how and where to access benefits (learning cost). The second is the stigma and public ridicule associated with participation in public pro-poor services due to lack of control and self-esteem (psychological cost). The third is the burden of compliance with programme rules of engagement (compliance cost). From this perspective, the hassles that beneficiaries endure to access the LEAP cash transfers constitute learning, psychological and compliance costs, which ultimately affect their overall well-being. These costs are interlinked, and beneficiaries endure them because they perceive the ultimate goal of receiving the benefits outweighs them. There is therefore an inverse relationship between the cost of administrative burdens to beneficiaries and its effect on beneficiaries’ well-being. Herd and Moynihan (2018) affirm this notion when they note that beneficiaries are rational beings and would pull out of the programme if they perceived the costs to outweigh the benefits.

Administrative Burdens in Cash Transfer Programmes

All social policy programmes are associated with administrative requirements that can be a burden on programme users. Administrative burdens include steps individuals must take to interact or engage with social programmes, including procedures and information requirements for accessing, applying and reporting. Existing research suggests that requirements tend to be more onerous in mean-tested transfer programmes that target poorer and more vulnerable populations (Moynihan et al., 2015). Means-testing is both an administrative and political instrument, strategically constructed by the state to restrict the less needy from competing or participating in social services or programmes (Álvarez et al., 2008) and involves more administrative work by governments and citizens to sort eligible citizens from those who are ineligible. Moreover, as support is often tapered according to need, additional administrative processes and information are required to determine levels of benefit to eligible recipients. Once eligibility is determined, administrative processes and information provision are periodically required to ensure ongoing eligibility and compliance with programme requirements, such as in conditional welfare (Watts & Fitzpatrick, 2018).

In their operations, social programmes often generate unintended consequences that undermine their potential to achieve their goals. When administrative burdens are high, they can lead to bureaucratic disentitlement whereby administrative procedures and bureaucratic discretion in practice restrict access to benefits to which people would be otherwise formally entitled. This may be deliberate for purposes of political objectives, control, discrimination or rationing of resources (Brodkin, 2007; 1997; Brodkin & Majmundar, 2010; Lipsky, 1984; Soss et al., 2011). Bhargava and Manoli (2015) found administrative burdens to be a significant explanation of the generally low participation or ‘take-up’ in mean-tested programmes targeted at socially disadvantaged people.

Yet administrative burdens and their impact within social protection programmes in developing countries have had limited investigation, particularly from beneficiaries’ points of view. For instance, employing a discrete duration model, Álvarez et al. (2008) evaluated the reasons for beneficiary dropout from Mexico’s Oportunidades programme. While their analysis indicates that the conditionality in the programme acted as a screening mechanism, with wealthier beneficiaries having greater odds of dropping out, administrative factors and the provider of health services to beneficiaries were key negative factors in whether beneficiaries stayed or left the programme. Their studies, like that of Molyneux (2006, 2007), further observed that the conditionality in Mexico’s PROGRESA re-traditionalised gender norms as women became the primary caretakers of children in households and were made responsible for their health and development.

Heinrich and Brill (2015) examined administrative burdens on benefit access to and impacts of the South African Child Support Grant (CSG) on beneficiaries’ children. Their findings show that as the age of eligibility and application requirements changed over time, approximately 60% of the sampled children experienced interrupted or disconnected receipt, associated with administrative errors. For both female and male adolescents, the timing and loss of the benefits were associated with higher rates of engagement in adolescent risky behaviours and for females, lower education attainment.

Other studies of South Africa’s CSG discovered that administrative requirements for a child’s birth certificate, identity documents for the mother or caregiver, a hospital card, Road to Health Card for the child (a health record) and proof of parental or caregiver income were important barriers to granting access (Department of Social Development (DSD), South Africa Social Security Agency (SASSA) and UNICEF, 2011; Mirugi-Mukundi, 2009; Zembe-Mkabile et al., 2012). The DSD–SASSA–UNICEF study further illuminated other documentations demanded in special circumstances, like a police affidavit, a letter with the ward councillor’s stamp to confirm proof of address and proof of (un)employment. These administrative burdens made it less likely for children whose mothers were deceased or absent to get access to the programme benefits, even though they are among the poorest and most vulnerable (Case et al., 2005; McEwen et al., 2009).

Mirugi-Mukundi (2009) and Goldblatt et al. (2006) on the same South African CSG programme observed administrative burdens like long queues and long waiting times at programme offices and payment centres, limited-service hours in application offices, travel costs and time and communication barriers associated with obtaining documentation had major implications for accessing the CSG benefits. Patel (2011) also noted inconsistency in the application of programme rules across government offices and a lack of knowledge about how and where to apply for benefits. Misinformation about eligibility and application requirements combined with travel times, long waits and loss of work time added to the costs of applying and barred eligible people from accessing the CSG (Zembe-Mkabile et al., 2012).

Like many development programmes in sub-Saharan Africa, SCT intervention evaluations and research have been dominated by quantitative survey-based methods and the use of ‘difference-in-difference’ econometric techniques (Devereux, 2013). However, quantitative methodologies provide limited insights into the complex ways in which SCT systems contribute to multi-dimensional well-being outcomes. Further, the evidence from these studies demonstrates that administrative burdens have high costs for cash transfer programmes, both individually and collectively. Hence, systematically exploring and understanding these burdens in different areas of policy implementation from beneficiaries’ point of view is significant.

Thus, the main objectives of the study are to examine micro-level administration burdens of SCTs and their consequent impacts on beneficiaries’ well-being.

The research question for the study is: How do programme administrative burdens impede beneficiaries from best attaining well-being?

Research Design

This study is based on 15 qualitative interviews conducted as part of a larger, mixed-method doctoral research. These 15 participants were purposefully selected from 332 household heads who had responded to survey questionnaires in the first phase of a PhD research. The 15 interviewees consisted of five each from the three categories of the survey respondents–the aged (five), disabled (five) and OVC caregivers (five)–were purposefully invited to volunteer for interviews. One male was purposefully selected from OVC households while two each were selected from aged and disabled households for interviews. The lesser number of male participants was due to the majority of survey respondents being female. The five participants from OVC households were all caregivers while the remaining 10 from the aged and disabled households were household heads and beneficiaries as well. The research was conducted in the Komenda-Edina Egyafo-Abirem district in the Central Region of Ghana. Interviews were conducted in the participants’ native language, audiotaped and transcribed first into their native language and then translated into English by the first author.

Transcripts were thematically analysed by using constant comparison derived from an iterative process of data collection, coding and analysis. A preparatory list of themes and categories relating to the factors that interviewees perceived to be relevant to their experiences of challenges were drawn up and altered as analysis continued and new ideas and concepts emerged. Confidentiality and anonymity were maintained by the use of pseudonyms.

The thematic analysis identified many aspects in which the design and operation of LEAP was creating negative well-being effects on households, in conjunction with the positive impact the financial payments enabled. The administrative burdens limiting the LEAP impacts are reported here. Findings are reported by the themes identified from our inductive analysis, with links made to Herd and Moynihan’s (2018), three-fold conceptual approach to administrative burdens.

LEAP Programme Administration Burdens

All respondents interviewed described and confirmed at least one or more administrative burdens as key challenges watering down the positive LEAP impacts on their well-being. Those reported here are inadequate information about the programme; transport, timing and financial barriers to accessing payments; irregularity of payments; difficulty with electronic payment system; gift giving to programme administrators; and lack of access to LEAP complementary services.

Inadequate Access to Programme Information

Inadequate information or communication was one common problem that beneficiaries’ interviews revealed. Many of the participants reported that their inability to access adequate and accurate information concerning the LEAP programme prohibited them from fully enjoying the LEAP benefits to improve well-being. One strategy of the LEAP programme is to provide timely information and education that would empower beneficiaries to access its benefits, including complementary services. However, participants reported that such education and information on the programme was rarely provided, hence, they lacked a full understanding of how the programme functions. This resulted in the LEAP programme being described both by the beneficiaries and the community at large with a catchphrase ‘ahiafoo sika’; in other words, ‘poor people’s money’, which participants thought was demeaning to their dignity (psychological cost). Inadequate information on the programme reduces their ability to access the LEAP benefits and brings considerable stress and frustration to them as they are unable to fully benefit from the programme and its complementary services (learning cost). For example, some beneficiaries lamented that:

The officers think lowly of us, they hardly come here to talk to us, let alone provide information about the programme. You will be here and the next day, payments would start without prior information, it is frustrating and stressful, to rush to access the benefits. (Kojo, male, aged respondent)

We don’t get information about the programme, ‘what and what’ benefits are part of the LEAP money, it looks like we are nobody to them, so they don’t tell us what is being planned with the LEAP, it is annoying and not nice. (Sara, female, caregiver participant)

It was found from beneficiaries’ interviews that the local structures for the implementation of the LEAP programme were malfunctioning, leading to inadequate provision of accurate information. According to the LEAP operational guidelines, the CLICs have the responsibility of day-to-day community-level administration, publicity and awareness-raising to educate beneficiaries about programme eligibility and recipients’ rights and entitlements. This includes benefit amounts, the frequency of payments and participant co-responsibilities, as well as resolution of problems beneficiaries face. Yet the CLICs were found to be ineffective or non-existent in the studied communities. Interviews with participants disclosed that they only receive scanty information about the LEAP payment from individual focal persons. The information from the focal persons sometimes was not consistent with the practical operation of the LEAP. One respondent explained:

If Madam Gladys [referring to the focal person] does not come here, we hardly get information about the LEAP. Sometimes even the information we get from her on payment days might not be true or correct. (Sara, female respondent)

The lack of accurate information, we observed, created social consequences of misunderstandings, heightened tension and confusion amongst beneficiaries and communities about how the LEAP programme functions (FAO, 2013).

Travel Costs, Long Queues and Waits at Service Centres and Payment Centres

Travel cost, long queues and waiting times in accessing LEAP grants and the complementary services (e.g., NHIS) arose as key administrative burdens that impeded effectiveness of the LEAP programme for beneficiaries. While some, particularly the disabled/elderly recipients, emphasised needing special vehicles to travel, which in most cases is out of their reach, those from remote communities described difficulties in accessing transport and the huge costs they incurred for travelling to the district capital, Elmina (learning cost). For instance, Araba (68, female aged participant) indicated that she spent almost GH¢10 in travelling to the district offices. Esi, Kwarfo, Georgina and four other respondents, narrated the distress they encounter in getting transport from their remote areas to the district offices. Some participants indicated that they walk 15 km to the next community before they can access transport. Others (nine out of the 15 respondents) also indicated long queues and waiting times at the service centres including cumbersome questioning, bad treatment like shouting, shaming and insolence from programme officers, as well as demands for proof of identity, discouraged them from taking the free NHIS complementary services (learning and psychological costs). For example, Kojo narrated that his previous bad experience with a programme officer and the long hours spent at the NHIS office discouraged him from going to renew his NHIS membership. He recounted spending all day in a long queue and when it got to his turn to be served, the NHIS officers requested proof of identity as a LEAP beneficiary, which impeded his registration, having lost productive hours in the queue. He vowed not to visit the office again.

Regarding the long queues and waiting times, we witnessed some in Komenda, Ankwanda, Kissi, Agona and Dabir during the fieldwork. On the day of payments, many of the recipients reported to the payment centres as early as 6.00 a.m., but payments started after 2 p.m. When respondents were asked why they reported early to the centre, Araba’s account below mirrors majority of the respondents’ experiences and attendant health challenges.

We do not know the actual time the officers will arrive in this community to pay. They normally come at any time and rush the payments and leave, if you are not near or late, they will return your money, so we come here early to join queues in order not to miss payment…. it is difficult and risky to our health, many of us come here with an empty stomach to wait and join the queues. Someone even collapsed last year here and nearly died.

Irregular and Delayed Payments

Another widespread problem that emerged from beneficiary interview accounts was in relation to LEAP payments. All interviewees expressed concerns regarding irregularity or frequent delays in payment of their LEAP grants. The grants are supposed to be paid bi-monthly, but beneficiaries reported that this seldom happens in practice. Delays in payment often affect the financial planning and spending patterns of beneficiaries. Consequently, beneficiaries become stressed and are unable to meet their basic well-being needs. Lady’s (female, caregiver, OVC household) experience sums up beneficiaries’ frustrations:

The delay in payment is worrisome. It makes life very difficult for us. Often, you have to borrow or rely on a benevolent agency or look for other ways of coping. People think the government is supporting us, so when you even ask for help, they think you are not prudent in money management.

The irregular payments made it difficult for beneficiaries to smooth consumption and plan for other livelihood activities. This resulted in some beneficiaries adopting a negative coping mechanism to survive. For instance, the delays in payments resulted in some beneficiaries engaging their younger children in an income-generating activity to increase the family income or borrowing money at high interest (psychological and compliance costs). In Atonkwa, Ankwanda and Benyadze communities, OVCs were reported to have intermittently dropped out of school to search for casual work to earn money for food, because of the delays in payments. Two caregivers from OVC households explained:

I wish my children will stay home to study after school, but because of the uncertainty or untimely payment of the LEAP money, they sometimes skip school or join me after school to trade (Esi female caregiver, OVC household).

This affects the children’s educational well-being and undermines the LEAP programme objective that seeks to invest in the human capital of children. Similar evidence was reported in Kenya’s CT-OVC programme implementation by Lichuma (2014), where children’s education was disrupted and the quality of learning at schools was affected.

Some disabled beneficiary heads resorted to street begging in the urban centres to survive. For instance, in an interview, Ishatu (Female disability beneficiary) explained that ‘if we don’t have money in this household, I travel to Takoradi or Kumasi to beg for money’. Resorting to street begging is worrisome as it puts these vulnerable people’s lives at high risk. Other beneficiaries, especially destitute households, relied on their extended families. One beneficiary said:

When the LEAP money gets delayed, I seek support from my younger sister, but her economic condition is not all that good. So, at times genuinely she doesn’t have money to help me. In such situations, I sometimes sleep without eating or food (Anua, male, aged household).

Interview participants from OVC households widely reported that they normally sold off assets such as clothes, jewellery and crops for the sake of feeding and schooling their children. The overall effect of delays in payment is that beneficiaries are unable to support their material well-being. Thus, it can be argued that LEAP has not yet realised its objective of improving the well-being of the ultra-poor in Ghana.

Difficulties with Payment Procedures

Another challenge relating to payment procedures, though not widespread, was the difficulty in accessing LEAP transfers using the electronic payment system (e-zwich payment). Beneficiaries reported that the electronic system normally fails to verify their eligibility for payment, which causes them to miss payments for months, thereby creating dissatisfaction and suspicion as beneficiaries begin to assume their names have been removed from the payment system (compliance cost). One beneficiary who has lost her hand due to leprosy lamented:

I do not understand why they are telling me that the device cannot recognise me. It is because I have lost my figures. Why now? I suspect they have removed my name from the system. Why do they want me to bring someone else to replace me? Am I not a human being too? (Ishatu, female disability beneficiary).

Though the electronic finger verification system was introduced to improve efficiency in the LEAP payments, problems were still observed with the use of the fingerprint verification system. Beneficiaries who could not be verified by the e-zwich device missed payments. Most of these beneficiaries are destitute and do not have productive capacity or livelihood activities and solely depend on LEAP transfers for surviving. The consequence of not being paid in a payment cycle has repercussions for their well-being.

It emerged that beneficiaries are advised to nominate a second receiver whose fingers could be verified by the device to collect the money on their behalf. However, many of the beneficiaries interviewed were of the view that they could collect the money on their own and were willing to do so. They were reluctant to use the second recipient option because there was suspicion that alternative recipients sometimes divert transfers or fail to deliver the full amount to beneficiaries. A similar study by FAO (2013) on LEAP observed that the use of alternative recipients often creates confusion because they are taken to be the main beneficiaries. Although beneficiaries missed payments, it was discovered during the interviews that they can access the missed payment during the next payment cycle. Beneficiaries can access missed payments because all payments are loaded onto a smart card, which indicates who has received payment or not. Beneficiaries’ ability to recover missed payments was a good thing, but missing payments until the next payment cycle reduced the potential of beneficiaries to achieve well-being.

Gift Giving to Administrators

Another salient issue from the interviews was that some beneficiaries or caregivers giving about 5% (GH¢ 2 ³ ) of their money to the focal persons ⁴ as gifts. This is because the focal persons always prompt beneficiaries about the payment days and in return, beneficiaries thank the focal persons by giving them money. Although this practice is unofficial and not part of the LEAP payment procedures, it is done to show appreciation for the work of the focal persons in the communities. However, there were mixed views among respondents about the practice. While some respondents think the practice conforms to the Ghanaian culture of appreciation, other respondents consider it to be extortion. In the Central region, for instance, the Fante culture encourages people to express appreciation in the form of gifts when something good is done to them by someone else. Some beneficiaries, therefore, see such a provision as a cultural obligation and do not resent giving. One respondent explained:

I do not see the GH¢ 2 payments as a problem at all; the focal person also helps us and you know in our culture, we must thank him or show our appreciation. (Anua, male, beneficiary respondent)

Although this could be interpreted as a positive cultural practice as it may promote community cohesion and motivate focal persons to work more, there is also the risk of people taking advantage of the practice to extort money from the beneficiaries. Reflecting this, some respondents gave opposing views (psychological cost):

I do not know why he collects this GH¢ 2, but I don’t want anybody to rain insults on me and since everybody pays, how would others see me if I refuse to pay? They will think I am not cooperative or ungrateful. So, I always give the GH¢ 2, though I am not happy giving such money to the focal person. (Kwafie, male, disability household)

I don’t ask what the GH¢ 2 is used for. Everybody pays to the focal person, so I also pay. The money that the government gives us is small and is unable to feed us, therefore, giving GH¢ 2 out, is something worrisome. (Georgina, female, aged household)

Most importantly, when recipients give away part of their LEAP grants to programme administrators, it reduces the value of their LEAP spending and invariably their well-being.

Access and Utilisation of LEAP Programme Complementary Services

The National Social Protection Strategy (NSPS) has listed several complementary social services that programme beneficiaries are supposed to benefit from. For example, beneficiaries who are 65 years and above are supposed to access the NHIS for free, get free bus rides and micronutrient supplements. Caregivers of OVC are supposed to benefit from the NHIS, receive agricultural input support and access microfinance. Finally, People with Disabilities are also supposed to benefit from the NHIS. Significantly, none of the 15 interviewees indicated they had accessed any complementary services in addition to money as outlined in the NSPS, other than the NHIS. Thus, except for the NHIS, no other stipulated complementary social services were available in the study communities. ‘We neither have free bus here, nor the other things mentioned in this community. It is only the NHIS we can access’ (Kwafie, beneficiary, aged respondent). Another participant explained that for many years they have requested for the government school feeding programme for their children without success, let alone free bus ride and accessing microfinance:

Even the school feeding programme we have been crying for, for years, for our children, they have refused to send one here and you are talking about microfinance. They only put these things on paper to deceive people. (Sara, female, caregiver respondent).

The non-existence of the complementary services undermines the objective of the LEAP to provide households or families with productivity-enhancing services that can help beneficiaries to be self-reliant and promote their well-being. There is a clear indication that beneficiaries of LEAP seemed unaware of their entitlements to the benefits of free NHIS registration and renewal. Rather, they used their own money for registration and renewal, thereby reducing the effectiveness of the productivity-enhancing services that complement LEAP to contribute to beneficiary households’ health and other well-being (learning and compliance costs). Using LEAP money to register or renew membership also reduces the financial security that LEAP provides to beneficiaries to achieve other well-being outcomes. Ato’s response reflects the broader view of beneficiaries:

We use our own money to renew the cards or even get registered. Nobody comes here to collect the cards for renewal or directs us where to renew or register the card. We are not sure whether the LEAP office is responsible or the NHIS office is. (Ato, male, aged respondent)

Probing the effectiveness of the NHIS membership to access healthcare, it was widely reported by beneficiaries that many of their ailments, particularly of the elderly, were not covered under the NHIS. One respondent indicated:

We avoid visiting the hospital, though we have an NHIS card because I don’t have the money to pay for the extra cost of the hospital bills (laboratory tests and medications). I often use herbal plants from the farm to treat my children’s ailments. (Lydia, Elizabeth, caregivers)

This situation limits access to health services and makes beneficiaries self-medicate, as noted by Anua (aged respondent); ‘We only visit the hospital when household member’s condition worsens, we normally self-medicate’. The adoption of self-medication or unscientific health practices in treating household ailments undermines the health well-being of beneficiary households (compliance cost).

Concluding Discussion

This article argues that consideration of micro-level administrative burdens associated with social protection programmes would not only allow for better understanding of their impacts but would also improve the design and delivery of social protection programmes and peoples’ well-being (McGregor et al., 2015a, 2015b). To address the research question of how do programme administrative burdens impede beneficiaries from best attaining well-being, it analysed qualitative data drawn from a sample of 15 participants. Thematically analysed interview data largely confirmed discussions in the literature as well as highlighted diverse challenges limiting the positive impacts of the LEAP programme for beneficiaries.

The findings confirm that administrative burdens are often associated with mean-tested programmes that target poorer populations (Zembe-Mkabile, 2012). The administrative burdens observed in this article included: inadequate access to programme information; travelling cost; long queues and waits at service and payment centres; irregular and delayed payments; giving gifts to programme administrators; and lack of accessibility and utilisation of complementary programme services.

Although it is established that administrative or procedural discretion in social policy is often used intentionally to restrict access to benefits (Mirugi-Mukundi, 2009), our findings show that the administrative burdens of the LEAP cash transfer programme generate consequences that trample upon the effects of the programme on recipients’ well-being. For example, the accounts revealed that lack of information and education on the programme caused some recipients to miss payments, to be unable to take up other social benefits, and thus failing in their co-responsibilities like non-involvement of their children in the labour market (Government of Ghana, 2013). This finding corroborates the qualitative evaluation of the LEAP by Handa et al. (2014), which found a significant number of LEAP beneficiary households not receiving sufficient information on LEAP intervention and this affected their spending and collective well-being. An evaluation of Brazil’s Bolsa Familia Programme was rated to be more effective because programme information and co-responsibilities were highly publicised on television, radio, and billboards, and in newspapers as well as through constant local community engagement (Lindert et al., 2007). The LEAP programme implementers should therefore take steps to ensure that programme requirements are communicated quickly and clearly and that local formal and informal infrastructure is used to communicate with and support recipients’ efforts to successfully access their benefits.

It further emerged from our findings that travelling costs, long queues and waiting times at service and payment centres, as well as delays in payments, resulted in beneficiaries either missing or abandoning benefits. Even though the NHIS registration was free for LEAP beneficiaries, recipients widely stated that document procedures, waiting time, queues and long distances between their communities and NHIS offices (mostly cited to be at the district capital) and cumbersome questions asked at the NHIS centres, lowered their interest in taking the NHIS membership. For recipients, the cost of accessing the NHIS membership is high. The time involved in travelling to the NHIS office, waiting time at the office and direct cash cost of transportation were high for more remote households. Households mostly compared the total costs, including opportunity costs, with the benefits associated with NHIS intervention (Ravallion, 2003), namely, the coverage of illness received from being an NHIS member. The inability of the programme to deliver and renew the beneficiaries’ NHIS membership has in some instances resulted in recipients abandoning the NHIS intervention. The general accounts indicated that not all LEAP recipients’ illnesses are covered under the NHIS scheme. The implication was that the less the coverage by the NHIS of recipients’ health issues, the more likely this would prevent some recipients from seeking healthcare, even if they apply for the NHIS membership.

The 2014 National LEAP evaluation report revealed that the increased number of LEAP beneficiaries registered under the NHIS led to an upsurge in the use of curative health care by 25% points, especially among children (Handa et al., 2014). The present analyses, however, suggest that they only access healthcare when a household member’s health is in a critical condition. They do not regularly visit health facilities because of high medical bills, which the NHIS does not cover. This finding is in line with a study by Evans et al. (2014) that found in Tanzania that CT intervention, although it led to an increased number of beneficiaries enrolled in health insurance, its use to access health facilities declined. The cause of such a decline was connected to the non-enforcement of clinic attendance requirements of the programme or a likelihood of overcrowding of clinics in beneficiary communities, which discouraged attendance.

Our study also confirmed that operational changes to the LEAP programme restricted recipients’ access to benefits. Our findings suggest that the introduction of an electronic fingerprint verification payment mechanism prevented the poor from accessing the cash transfer programme designed to help them. While the new payment system can potentially promote efficiency and eliminate corruption, it has generated some problems because of operational misfortunes. Some recipients could not be verified for payments through the fingerprints system and this restricted their payments. This has strong repercussions for their well-being as some beneficiaries are destitute because they do not have any productive capacity or livelihood activities and solely depend on the LEAP transfers to survive. It was understood from the recipients’ accounts that the second recipient option verification proposed by programme implementers was commonly unacceptable to the beneficiaries due to suspicion that alternative recipients can divert transfers or fail to deliver the full amount to the main recipients (see FAO, 2013).

Irregularity in benefit payments also resulted in some beneficiaries resorting to alternative coping mechanisms, such as begging, selling their assets, skipping meals, involving their children in paid labour and use of unscientific herbal medicines for treating ailments. These findings reiterate earlier studies that found delayed and irregular payments were the major problems that LEAP beneficiaries faced (FAO, 2013; Handa et al., 2014).

Our findings further observed that recipients give money gifts to programme administrators due to stigma and fear of losing their benefits (psychological and learning cost). Beneficiaries give such money for fear of stigma or insults from others and not because they are willing to offer an appreciation or gift (psychological cost). This in turn reduces the benefits of the LEAP grants for households to meet well-being needs. Such practice has the potential to institutionalise corruption in the LEAP programme. The evidence suggests that these beneficiaries are compelled to pay the money. They give because of the fear of being stigmatised. The practice raises the issue of the effectiveness of the LEAP monitoring and reporting mechanisms for beneficiaries to seek redress for such concerns.

Against the backdrop of the administrative burden’s framework of Herd and Moynihan (2018), the findings show that beneficiaries of LEAP cash transfers experience learning, psychological and compliance costs in the process of accessing the LEAP cash transfer and its complementary services (such as free health service and free basic education). These costs notwithstanding, the beneficiaries continued to remain in the programme because they perceived the ultimate benefits to outweigh the costs since they are extremely poor people with limited well-being options. In instances where the cost was perceived to outweigh the benefit, beneficiaries failed to comply. If administrative burdens under LEAP were minimised, beneficiaries would not only enjoy the full benefits under the programme, but also fully comply with the LEAP cash transfer rules and conditionalities.

In conclusion, we note that while the LEAP programme was expected to provide a safety net for the poorest, the programme is not fully delivering on its intended purpose due to administrative burdens. These challenges place beneficiaries in hardship conditions by causing them to slip through the safety net. To enhance beneficiaries’ capacity to use LEAP transfers to achieve satisfactory well-being outcomes, there is an urgent need to find an effective means of providing adequate and timely information, feedback mechanism and monitoring and other productivity-enhancing services to complement the LEAP grant, thus strengthening the local implementation structures, and payment procedures as well as reducing travelling costs and waiting times for service delivery. Although the study has limitations such as a small number of 15 interviews conducted in a district in Ghana, meanings lost in translation and our interpretations, the administrative issues it raises and the effective implementation solutions it seeks are globally applicable in similar contexts. Three key messages of the article are: Appreciating micro-level experiences of administrative burdens and its implications associated with cash transfer programme implementation is essential for programme effectiveness. Administrative burdens associated with the LEAP cash transfer programme, if not curtailed, affect beneficiaries’ access to the grant and their well-being. Improving grassroots information sharing and local structures will potentially reduce administrative burdens in the implementation of cash transfer programmes.