REFANI Pakistan Country Study

The REFANI-Pakistan study was a cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of different cash transfer programmes on child nutrition status (ISRCTN 10761532).

The impact results of the study can be accessed here, and the cost-effectiveness results of the study can be accessed here

Study Background

Pakistan is the 36th largest country in the world (in terms of area) and has a population which exceeds 191,000,000, with approximately 34% of the population younger than 14 years of age. According to UNICEF, 32% of children in Pakistan are underweight, with an estimated 35% of child deaths in Pakistan being linked to undernutrition. Persistent and pervasive, undernutrition is found in both urban and rural areas, as well as across multiple income groups. The highest prevalence of undernutrition among children is found in Sindh province, which has a global acute malnutrition (GAM) rate of 17.5% (well above the emergency threshold of 15%). 

Since 2013, Action Against Hunger has been implementing the European Union funded Women and children/infants Improved Nutrition in Sindh (WINS) programme, a four year integrated food security and nutrition project aimed at improving the nutritional status of women and children in Sindh province.

Led by ENN, with the support of Action Against Hunger, the REFANI Pakistan study analysed the short and medium-term effectiveness of cash transfer programmes (CTPs) on reducing the risk of undernutrition in women and children. Specifically, the study explored how effective the CTPs were in reducing the prevalence of wasting (measured as weight-for-height) in children under 5 years of age. Secondary research questions included: how did the different cash transfer modes (cash or voucher, or amount of cash) affect nutritional status and what were the factors that determined how households used the cash transfers?

In addition to the nutritional impact study, Action Against Hunger led a cost-effectiveness analysis in Pakistan, which used qualitative and quantitative methods to assess the financial aspects of the programme, using a societal perspective. For more information, please refer to the REFANI Cost-Effectiveness Analysis brief.

For more information on the REFANI Pakistan study please refer to the REFANI Pakistan Brief.


Action Against Hunger is leading a global movement to end hunger in our lifetimes. It innovates solutions, advocates for change, and reaches 26 million people every year with proven hunger prevention and treatment programs. As a nonprofit that works across 50 countries, its 8,300 dedicated staff members partner with communities to address the root causes of hunger, including climate change, conflict, inequity, and emergencies. It strives to create a world free from hunger, for everyone, for good.