Evaluation of the Group Problem Management Plus (Group PM+) Pilot Study in Oromia and Amhara Regional States, Ethiopia
Phase: NA
Conditions: Mental Health Issue
Sponsor: International Food Policy Research Institute

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Evaluation of the Group Problem Management Plus (Group PM+) 
pilot study in Oromia and Amhara Regional States, Ethiopia 
 
 
Melissa Hidrobo1, Harold Alderman1, Negussie Deyessa2, Dan Gilligan1, Parthu Kalva1, Jessica 
Leight1, and Michael Mulford3 
 
 
Affiliation 
1 International Food Policy Research Institute, USA 
2 Department of Preventive Medicine, School of Public Health, Addis Ababa University  
3 Michael Mulford, Chief of Party, World Vision 
 
 
 
 
October 10, 2022 
 
 
 

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Table of Contents 
page 
Introduction .................................................................................................................................................. 3 
Objective ....................................................................................................................................................... 4 
General Objective ..................................................................................................................................... 4 
Research questions ................................................................................................................................... 4 
Background ................................................................................................................................................... 4 
Study setting ............................................................................................................................................. 4 
Interventions ............................................................................................................................................. 5 
Study design .................................................................................................................................................. 6 
Randomization .......................................................................................................................................... 7 
Study population ....................................................................................................................................... 8 
Sample and power calculations .................................................................................................................... 8 
Power calculations .................................................................................................................................... 8 
Sample procedures ................................................................................................................................. 10 
Data Collection ............................................................................................................................................ 10 
Screening Survey ..................................................................................................................................... 11 
Baseline and end-line surveys ................................................................................................................. 11 
Estimation ................................................................................................................................................... 12 
Primary and secondary outcomes .......................................................................................................... 12 
Empirical approach ................................................................................................................................. 14 
References .................................................................................................................................................. 16 
 
 
 
 

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Introduction 
Mental health disorders are among the leading causes of the global health-related burden. Mental 
health disorders are exacerbated by poverty and exposure to adversity such as conflict and negative 
shocks. The Global Burden of Disease Study (2020) showed that the two most disabling mental 
health disorders were depressive and anxiety disorders. Both ranked among the top 25 leading 
causes of burden worldwide in 2019, with an estimated 3 to 4 percent of the global population 
suffering from each (Abbafati et al. 2020). Among conflict-affected populations, estimated 
prevalence of mental disorders rises to 22.1 percent (Charlson et al. 2019). Despite the high 
prevalence, adequate care for mental illness is mainly inaccessible in low and middle-income 
countries. The treatment gap (the percentage of individuals who require care but do not receive the 
treatment) is estimated at 80% (Ridley et al. 2020). 
Recent work in economics and psychology suggests that poverty and low psychological well-being 
may mutually reinforce each other. For example, poverty may lead to stress, which can cause 
mental health challenges (Chemin, De Laat, and Haushofer 2013; Hammen 2005). Conversely, 
mental health challenges may affect labor market participation and productivity and thus may 
exacerbate poverty (Haushofer and Fehr 2014; Ridley et al. 2020). This potential feedback loop 
suggests that interventions that alleviate poverty may effectively reduce poverty and improve 
mental health. Similarly, interventions targeting mental health may improve mental health and 
poverty. Alternatively, if mental health and poverty are strong complements, interventions that 
address both poverty and mental health jointly may be most effective in improving both outcomes 
(Elliott, 2016, Lund, 2012).  
The widespread incidence of common mental health disorders calls for psychotherapy models that 
may be more scalable and flexible to address multiple mental health-related problems. Given the 
bidirectional link between poverty and mental health and the limited mental health treatment in 
many low income settings, combining antipoverty interventions with psychotherapy delivered by 
non-specialists may be promising (Ridley et al. 2020). Using a randomized control trial design 
(RCT), this study will compare the impact of a psychotherapy program with and without a one-
time lump sum cash transfer on measures of both economic and psychological well-being 
outcomes.  

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Objective 
General Objective 
The study’s objective is to estimate the impact of group Problem Management plus (GPM+), with 
and without a lump-sum cash transfer, on mental health, daily activities, and economic outcomes 
among Productive Safety Net Program (PSNP) clients in the regions of Amhara and Oromia.  
Research questions 
The specific research questions to be answered are:  
1) What is the impact of gPM+ on PSNP clients’ mental health and daily activities 
immediately after gPM+ sessions end?;  
2) What is the impact of gPM+ on PSNP clients’ mental health, daily activities, and economic 
well-being 1-year after gPM+ sessions end?  
3) What is the impact of a one-time lump-sum cash transfer on mental health, daily activities, 
and economic well-being 1-year after gPM+ sessions end?;  
4) What is the added impact of combining gPM+ with a one-time lump sum cash transfer one 
year after gPM+ sessions end?  
Background 
Study setting 
Since its inception in 2005, PSNP has been a cornerstone of the Ethiopian government’s strategy 
for poverty alleviation, disaster risk management, and rural development. The PSNP provides food 
or cash transfers targeted to poor households through payments for seasonal labor on public works 
or direct support to families whose primary income earners are elderly or disabled. With more than 
8 million beneficiaries, the PSNP is one of Sub-Saharan Africa’s most prominent social protection 
programs. The PNSP has played an essential role in improving the lives of poor Ethiopian 
households by reducing household food insecurity, increasing asset holdings, and improving 
agricultural productivity (Berhane et al. 2014; Hoddinott et al. 2017). 
The Strengthen PSNP5 Institutions and Resilience (SPIR II) Resilience Food Security Activity 
(RFSA) in Ethiopia is a five-year project (2021-2026). This is a graduation model social protection 
program that supports the implementation of the fifth phase of the Productive Safety Net Program 
(PSNP5) in the Amhara and Oromia regions and provides complementary livelihood, nutrition, 

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gender, and climate resilience activities to strengthen the program and expand its impacts. World 
Vision leads the implementation of the SPIR RFSA which will serve nearly 500,000 PNSP clients 
in Ethiopia’s most vulnerable woredas in Amhara and Oromia regions. As part of its activities, 
World Vision and implementing partners will implement the gPM+ and cash transfer interventions. 
This study will be conducted in 70 kebeles from 13 Woredas across the Oromia (5 Woredas) and 
Amhara (8 Woredas) regions of previous SPIR I study sites.1 Many adverse events have affected 
these kebeles, including political conflict, COVID-19, fall armyworm, and desert locust 
infestations. The proportion of fall army-worm and desert locust-affected households is higher in 
Oromia than in Amhara, with 35 (Amhara) and 65 percent (Oromia) of households reporting crop 
loss due to either desert locust or fall army-worms (Alderman et al. 2021). Even before the recent 
conflict, which has affected large parts of the country, a phone survey conducted during COVID-
19 (June 2020) among SPIR I households found high levels of self-reported stress, with about 35% 
of respondents in Amhara and 85% in Oromia reporting being extremely stressed (Alderman et al. 
2020). Depressive symptoms were also high among men and women in SPIR I study areas, with 
approximately 24-28 percent of males and females revealing mild-to-severe levels of depressive 
symptoms (PHQ-9>=5) and 4.6–6.2 percent moderate-to-severe levels (PHQ-9>=10) of 
depressive symptoms (Alderman et al. 2021). The mild-to-severe rates are slightly higher than the 
22% prevalence rate of common mental illness reported in a systematic review of the general 
Ethiopian population (Kassa and Abajobir 2018). 
While mild to severe depression is common in these study sites, treatment is limited. Most 
psychiatric services are concentrated in Addis Ababa, although the National Mental Health 
Strategy developed in 2012 aims to decentralize and integrate mental health services into primary 
health care (Hanlon et al. 2019; Negash et al. 2020). 
Interventions 
Problem Management Plus (PM+) is an intervention developed by WHO in 2013 to address 
common mental health problems such as depression, stress, and anxiety. It involves problem 
management (PM) plus (+) selected behavioral strategies to address both psychological issues 
(e.g., stress, fear, feelings of helplessness) and practical problems (e.g., livelihood problems, 
 
1 Amhara: Sekota; Gazgibla; Dahina; Bugna; Lasta; Gazo; Wadla; Meket. Oromia: Girawa; Kurfachele; Gemechis; 
Darolebu; Chiro 

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conflict in the family) (World Health Organization 2016). It was conceived initially as individual 
counselling composed of 5 sessions. It has been adapted to a group intervention (gPM+), with 
studies in Nepal and Pakistan demonstrating its effectiveness and feasibility (Rahman et al. 2019; 
Jordans et al. 2021). It is an intervention designed to be scalable and implemented by non-
specialists following brief training. World Vision will adapt the gPM+ materials to the local 
context in Amhara and Oromia study regions.  
In villages randomized to the gPM+ treatment, same-sex therapy groups of 3 to 8 individuals will 
be formed and facilitated by Community Health Facilitators (CHF) for women and Men’s Group 
Facilitators (MGF) for men2. Most CHF and MGF have experience facilitating prior mental health 
interventions, including interpersonal psychotherapy group (IPT-G) in SPIR I, and will receive a 
9-day training related to gPM+. The gPM+ intervention consists of five, 90-minute group sessions 
which will be delivered weekly over five weeks by the trained CHF and MGF.  
Eligible households in villages randomized to the Cash treatment will also receive a one-time lump 
sum transfer worth the equivalent value in Birr of $300 USD. While the transfer is unconditional, 
it will be presented as a ‘livelihoods transfer’ to support income-generating activities that improve 
livelihoods. The transfer will be at the household level, so the total amount is the same regardless 
of whether one or two individuals per household participate in the study. The transfer will be timed 
to be distributed one to two months after the last gPM+ session. 
Study design 
The impact of gPM+ will be assessed through a two-stage cluster randomized control trial (cRCT) 
design. In the first stage, 70 kebeles will be randomized to receive cash or no cash. Randomization 
of the cash treatment is at the kebele level in order to reduce the risk of spillovers, contamination, 
and resentment. Randomization of kebeles will be stratified by woreda. In the second stage, within 
each kebele, up to 6 villages will then be randomized to receive either gPM+ or not receive it3, 
leading to the following four intervention arms across 252 villages:  
• Arm-1: control 
• Arm-2: gPM+ only 
 
2 Group size will depend on how many individuals are screened in per village 
3 Although most kebeles have between 3-5 villages, the exact number of villages per kebele varies. 

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• Arm-3: lump-sum cash transfer only 
• Arm-4: lump-sum cash transfer and gPM+.   
Study participants in all intervention arms will receive information on locally available mental 
health services and be PSNP public works clients. Arm 2 will additionally provide study 
participants with the gPM+ therapy, Arm 3 will additionally provide a one-time lump sum cash 
transfer, and Arm 4 will provide both the gPM+ and cash transfer.  
The evaluation will include a baseline survey conducted before implementing the gPM+ or cash 
transfer intervention (July-August 2022, see Figure 1). The endline survey will be conducted on 
the same individuals right after the gPM+ intervention but before the cash is rolled out (September-
October 2022). A one-year post-intervention survey will be conducted approximately one year 
after the end-line, approximately one year after the gPM+ sessions and 9 months after the cash 
transfer (September-October 2023).  
 
Randomization 
Randomization was conducted in STATA by the research team using the randtreat command. First, 
70 kebeles were stratified by woreda, and randomized to either the Cash or No-Cash treatment. 
Second, 252 villages were stratified by kebele and randomized to either receive or not receive the 
gPM+ intervention. At each stage, misfits were randomly assigned within each strata, leading to 
slightly unequal number of villages per treatment arm (See figure 1). 
Figure 1: Study design 
                
           
              
              
              
              
            
             
              
            
          
            
               
             
              

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Study population 
The population for this study are individuals residing in Amhara and Oromia and registered and 
assisted by PSNP public works program. Moreover, to be eligible, individuals must have signs and 
symptoms of depression or dysfunction, be between 18 and 59 years old, and be the main decision-
maker or spouse of the main decisionmaker. The last criterion is added because we are interested 
in the relationship between mental health and economic decision-making, which is more relevant 
for the main household decision-makers. We allow both the primary decision-maker and spouse 
to be eligible because depression across spouses is often correlated, and therapy may be more 
beneficial when both are treated. Individuals will be excluded from the study if they present 
evidence of severe depression or suicide. A quick screening exercise will be conducted in the 
selected villages to identify eligible participants. The screening exercise will be based on the PSNP 
client list and include a brief survey that screens individuals for inclusion in the study (see section 
on “Screening survey” for more detail). 
Sample and power calculations 
Power calculations 
Power calculations for this study focused on a primary mental health outcome, PHQ-9, and 
economic outcome, the total value of productive assets. PHQ-9 is a widely used depression 
diagnostic instrument with scores that range from 0-27. For both outcomes, we drew on data from 
the endline SPIR I impact evaluation conducted in the same regions of Oromia and Amhara. Given 
          
                  
               
                  
        
               
        
              
        
                
             
                                   
                                     

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that SPIR I data did not have data on daily activities, we did not conduct power calculations on 
this outcome. 
We power the study for estimating impacts 1-year after the gPM+ sessions ended across the 4 
intervention groups as this requires the largest sample. Power calculations considered the study’s 
design, adjusting for clustering and autocorrelation. Autocorrelations were estimated using the 
SPIR endline and midline data, while intra-cluster correlations (ICC) were assessed at the kebele 
level. Power calculations were conducted in STATA using clustersampsi command. The desired 
statistical power was set at 80%, and the desired significance level was set to 0.05. Given that the 
number of kebeles, villages, and gPM+ group size were pre-determined, we calculate the minimal 
detectable effect at 1 year post gPM+ for a given number of clusters and cluster size.   
We set the number of villages to 252. The number of individuals per village will depend on the 
number of individuals screened into the study. The max gPM+ group size is 8 women and 8 men 
per village and the minimum is 3 women and 3 men. On average we expect about 12 individuals 
per village (6 men and 6 women) at baseline with a coefficient of variation of 0.25.  Assuming 8% 
attrition, rounded to the nearest whole number, the number of individuals per village at 1 year post 
endline is 11, for a total of 2,772 individuals. For household level economic outcomes, the number 
of households is estimated differently as two individuals per household (main decision-maker and 
spouse) are eligible to participate in the study. We expect about 18 percent of the sample to be 
husband/wife pairs from the same household. This will reduce the number of observations for 
household-level economic outcomes to 2,218 households. 
These parameters give us a minimal detectable effect (MDE) of 0.22 standard deviations on the 
PHQ-9 score and 0.25 standard deviations on the value of productive assets (Table 1), both which 
are considered small effect sizes. The MDE for the PHQ-9 is a lower bound effect size comparable 
to those found in Nepal and Pakistan (0.2-0.38 mean standardized difference for PHQ-9) 3-months 
after the gPM+ intervention (Jordans et al. 2021; Rahman et al. 2019).  
Table 1: Minimal detectable effect for given sample at 1-year post-program data collection 
 
MDE 
(SD) 
ICC 
Corr 
K 
villages, 
per arm 
N per 
cluster 
N per 
arm 
Total sample at  
1 year  
post program 
PHQ-9 score  
0.22 
0.13 
0.29 
63 
11 
693 
2,772 
Value of productive 
0.25 
0.16 
0.23 
63 
9 
567 
2,268 

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assets 
*2nd stage comparison of villages across the four different treatment arms 
Sample procedures 
The study will be conducted in the regions of Oromia and Amhara. 70 kebeles across 13 Woredas 
will be purposively sampled according to prior SPIR activities. In particular, sampled kebeles will 
be those that 1) previously received enhanced nutrition interventions under the SPIR I either 
through Community Health facilitators or Men’s Group Facilitators and thus have trained staff, 2) 
are not immediately adjacent to areas experiencing armed conflict, and 3) are accessible. Within 
each of the 70 selected kebeles, up to six villages with at least 10 PSNP households will be eligible 
to participate and chosen randomly.4 Most kebeles have between 3-5 villages with at least 10 PSNP 
households. In these cases, all villages within the kebele will be included in the study. In the rare 
cases where there are more than 6 villages per kebele, the largest 6 villages will be chosen to be 
included in the study.5 
In each village, up to 50 PSNP households will be screened for eligibility into the study.6 In 
villages with less than 50 PSNP households, all households will be screened. For villages with 
more than 50 PSNP households, households will be randomly ordered and the first 50 will be 
selected for screening. Through the screening survey, up to eight men and eight women per village 
who meet the inclusion criteria (the three criteria are: 1) are between 18-59 years old, 2) shows 
signs of depression or dysfunction as described below, 3) are the main decisionmaker or spouse) 
will be included in the study. 
Data Collection 
Laterite will lead the fieldwork for data collection in close cooperation with the IFPRI evaluation 
team. Laterite is a data, research, and technical advisory firm specializing in data collection and 
development research projects in East Africa. The data collection will consist of a short screening 
survey in study villages (June 2022), followed by a baseline survey a few weeks later (July-August 
 
4 Villages with less than 10 PSNP households were dropped as they would likely not have enough eligible participants 
to form a gPM+ group. 
5 We only keep a maximum of 6 villages, due to logistical constraints in implementing the gPM+ intervention. We 
keep the largest 6 villages, because we expect only a fraction of PSNP households to exhibit signs of depressive and 
be eligible for the study. 
6 We expect about 30% of households screened to be eligible to participate in the study. Given that we were aiming 
for groups of 8 men and 8 women to participate in gPM+, we expected that 50 households for the screening would be 
sufficient to reach this maximum group size.  

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2022) for individuals screened into the study. Following the intervention, two endline surveys will 
be conducted. The first will occur right after the intervention is completed (Sept-Oct 2022), and 
the second will be a 1-year post-intervention (Sept-Oct 2023).  
Screening Survey 
The screening survey will be conducted on PSNP clients in each study village to assess whether 
individuals are eligible to be included in the study. Per household, up to two people aged 18-59 
years will be screened (the primary decision-maker and spouse). The screening survey will assess 
depression and functionality using the Patient Health Questionnaire (PHQ-9) and the WHO 
Disability Assessment Schedule 2·0 (WHODAS). We plan to use a cutoff of 5 for the PHQ-9 and 
17 for the WHODAS. The PHQ-9 has been validated in Ethiopia, and a cutoff of 5 has been 
identified as optimal for identifying possible depressive disorders in primary care settings in 
Ethiopia (Hanlon et al. 2015; Keynejad et al. 2020; Bitew et al. 2021).  
Although not all villages in the study will be assigned to gPM+, the screening assessment will 
occur in all villages to ensure that the sample selection criteria are similar across villages. All 
individuals that are screened into the study will receive information on locally available mental 
health services and be informed that they may be contacted again in a few days to conduct the 
longer baseline interview. In contrast, those with severe forms of depression (a PHQ-9 score of 20 
or above) or those having suicidal attempts or ideations, assessed by the safety protocol, will be 
referred to health facilities with psychosocial support services under supervision by a focal person 
and will not be included in the study. 
Baseline and end-line surveys 
The baseline and endline questionnaires will be questionnaires of approximately 1:30 hours. The 
questionnaires will be conducted using Computer Assisted Personalized Interviews (CAPI) on 
tablets with SurveyCTO software. The questionnaires will be translated into Amharic and Afan 
Oromo, and interviews will be conducted in these two languages. The surveys will be composed 
of two parts. The first part will comprise household-level modules such as household roster, 
housing, assets, consumption, food security, investments, and occurrence of shocking events. The 
second part will be composed of individual-level modules administered to the individuals screened 
for the study. These modules include instruments for measuring depression, stress, anxiety, coping, 
self-efficacy, time and risk preference, savings, intimate partner violence, time use, and childcare. 

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At baseline, we will collect basic demographic information. At endline, we will ask about 
participants' experience with the gPM+ therapy and at 1 year post endline, their experience with 
the lump-sum cash transfer. 
Estimation 
Primary and secondary outcomes 
The study’s primary outcomes are those related to mental health, economic standing, and daily 
activities and childcare (Table 2). The mental health-related outcomes include depressive 
symptoms as measured by the PHQ-9, stress as measured by the Perceived Stress Scale (PSS-10), 
post-traumatic stress as measured by the PCL-C, anxiety as measured by the General Anxiety 
Disorder 7 (GAD-7-), and functional impairment as measured by the WHO Disability Assessment 
Schedule 2.0 (WHODAS 2.0). The economic outcomes include the total value of productive 
assets; total value of per capita consumption expenditures, food insecurity, and savings. Lastly, we 
are interested in how improved mental health leads to improved time-use and care activities. Thus 
our third set of outcomes include time-use with respect to non-economic activities, income-
generating activities, other activities, and childcare and discipline. Given that some outcomes may 
take more time to change and the cash transfer was rolled out after the endline, some outcomes 
(mainly the economic outcomes) will be analyzed only at 1 year-post endline.  
For all primary outcomes we will create raw scores and standardized scores.  Results on raw scores 
will be reported in the appendices. We will also create summary indices at the domain level 
following Kling et al. 2007.  
Table 2: Primary outcomes 
Domain 
Indicators 
Endline 1-year 
post 
endline 
Mental health 
PHQ-9 – a measure of depressive symptoms 
– total score from 9 questions converted to 
standardized unit using control mean and SD 
X 
X 
Perceived stress scale (PSS-10) – total score 
from 10 questions converted to standardized 
unit using control mean and SD 
X 
X 
Post-traumatic stress, PCL-C – total score 
from 6 questions converted to standardized 
unit using control mean and SD 
X 
X 

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General Anxiety Disorder 7 (GAD-7-) – total 
score from 7 questions converted to 
standardized unit using control mean and SD 
X 
X 
WHO Disability Assessment Schedule 2.0 
(WHODAS 2.0) – total score from 12 
questions converted to standardized unit 
using control mean and SD 
X 
X 
Economic 
The total value of productive assets- total 
value transformed using inverse-hyperbolic 
sine transformation and then standardized 
using control mean and SD 
 
X 
Total value of monthly per capita 
expenditures – total value of food and non-
food consumption transformed using 
inverse-hyperbolic sine transformation and 
then standardized using control mean and SD 
 
X 
Food insecurity experience scale- total score 
converted to standardized unit using control 
mean and SD 
 
X 
Savings- binary indicator that equals one if 
individual deposited any money in the last 
12 months in any type of savings account, 
converted to standardized unit using control 
mean and SD 
 
X 
Activity and childcare 
Non-economic activities: total hours spent in 
non-economic activities in the last 24 hours, 
converted to standardized unit using control 
mean and SD 
X 
X 
Income generating activities: total hours 
spent in income generating activities in the 
last week, converted to standardized unit 
using control mean and SD 
X 
X 
Other activities: summation of number of 
other activities participated, converted to 
standardized unit using control mean and SD 
X 
X 
Childcare – total number of activities, 
converted to standardized unit using control 
mean and SD 
X 
X 
Child discipline: total score, converted to 
standardized unit using control mean and SD 
X 
X 
Child neglect : total score, converted to 
standardized unit using control mean and SD 
X 
X 
 

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In addition, to the primary outcomes of interest, we are interested in potential pathways through 
which the gPM+ and cash could improve mental health and economic outcomes. These secondary 
outcomes include improvements in an individual’s coping skills (as measured by an abbreviated 
Brief Cope, Tension reduction, alcohol and khat consumption, and social support), psychosocial 
skills (as measured by general self-efficacy); intrahousehold relationships (as measured by the 
WHO Violence Against Women Instrument for IPV), and economic preferences such as time and 
risk (as measured by the Global Preference survey) and subsequent investments. These outcomes 
are listed in Table 3.  
 
Table 3: Secondary outcomes 
Domain 
Measure 
Coping mechanisms 
Alcohol and Khat consumption 
Tension reduction 
Brief Cope (shortened to 6 items) – instrument to 
measure coping with stressful life events 
Multi-dimensional Scale of Perceived Social 
Support (MSPSS) 
Psychosocial skills 
General self-efficacy 
Preferences 
Time preference (Global preference survey) 
Risk preference (Global preference survey) 
Value of Investments in last 12 months 
Intrahousehold relationships 
Intimate Partner Violence (WHO violence against 
women instrument) 
 
Empirical approach 
Impacts will be measured immediately following the intervention (endline) and 1-year post-
program. We will estimate intent-to-treat (ITT) effects following the assigned treatment using the 
ANCOVA model when baseline outcome variables are available. We will run probit models for 
binary outcomes and ordinary least squares models for continuous variables. 
R1: What is the immediate impact of gPM+ on mental health and daily activity? 
To answer the first research question, we will rely on the baseline and endline data. Given that the 
cash transfer has not yet been distributed, we will combine arms 1 and 3 (no gPM+) and arms 2 
and 4 (gPM+) to estimate the following equation: 

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𝑌𝑖ℎ𝑣𝑘
1
= 𝛽0 + 𝛽1𝑔𝑃𝑀𝑣𝑘+ 𝛽2𝑋𝑖ℎ𝑣𝑘
0
+ 𝛽3𝑌𝑖ℎ𝑣𝑘
0
+ 𝜇𝑘+ 𝜀𝑖ℎ𝑣𝑘    (EQ 1) 
Where 𝑌𝑖ℎ𝑣𝑘
1
 is the outcome of interest at endline for individual i from household h from village v 
in kebele k; and 𝑌𝑖ℎ𝑣𝑘
0
 is the outcome of interest at baseline. 𝑔𝑃𝑀𝑣𝑘 is an indicator that equals one 
if village, v, was randomized to the gPM+ treatment. 𝑋𝑖ℎ𝑣𝑘
0
 is a vector of baseline control variables 
that will include age and sex of the respondent for individual level outcomes. As a robustness 
check other possible baseline control variables will be included such as enumerator sex and the 
number and age of children (for childcare outcomes). The specification also includes kebele fixed 
effects, 𝜇𝑘. Standard errors will be clustered at the village level. We will assess heterogeneity of 
impacts by sex of the study participant, region, and PHQ-9 score as measured in the screening 
survey. 
R2-R4: What is the impact of gPM+ on PSNP clients’ mental health, daily activity, and economic 
well-being 1-year after gPM+ sessions end?  What is the impact of a one-time lump-sum cash 
transfer on mental health, daily activity, and economic well-being 1-year after gPM+ sessions 
end?; What is the added impact of combining gPM+ with a one-time lump sum cash transfer one 
year after gPM+ sessions end?  
To answer research questions 2-4, we will rely on the baseline and 1-year post-endline data The 
main specification we will estimate is the following: 
𝑌𝑖ℎ𝑣𝑘𝑤
2
= 𝛽0 + 𝛽1𝐶𝑎𝑠ℎ𝑘𝑤+ 𝛽2𝑔𝑃𝑀𝑣𝑘𝑤+ 𝛽3𝐶𝑎𝑠ℎ𝑘𝑤∗𝑔𝑃𝑀𝑣𝑘𝑤+ 𝛽4𝑋𝑖ℎ𝑣𝑘𝑤
0
+
𝛽5𝑌𝑖ℎ𝑣𝑘𝑤
0
+ 𝛾𝑤+ 𝜀𝑖ℎ𝑣𝑘𝑤       (EQ 2) 
Where 𝑌𝑖ℎ𝑣𝑘𝑤
2
 is the outcome of interest at 1-year post-endline for individual i from household h 
from village v in kebele k and woreda w; and 𝑌𝑖ℎ𝑣𝑘𝑤
0
 is the outcome of interest at baseline. 𝐶𝑎𝑠ℎ𝑘𝑤 
is an indicator that equals one if kebele, k, was randomized to the one-time lump-sum cash 
treatment; 𝑔𝑃𝑀𝑣𝑘𝑤 is an indicator that equals one if village, v, was randomized to the gPM+ 
treatment. 𝑋𝑖ℎ𝑣𝑘𝑤
0
 is a vector of baseline control variables that will include age and sex of the 
respondent for individual level outcomes. The specification also includes woreda fixed effects , 𝛾𝑤. 
As a robustness check we will also run a specification with kebele fixed effects and other possible 
baseline control variables will be included such as enumerator sex and the number and age of 
children (for childcare outcomes). Standard errors will be clustered at the village level. We will 

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assess heterogeneity of impacts by sex of the study participant, region, and PHQ-9 score measured 
in the screening survey. 
In this model, 𝛽1 measure the impact of the cash treatment compared to the control group 1-year 
after the gPM+ sessions ended; 𝛽2 the impact of the gPM+ treatment compared to the control group 
1-year after the gPM+ sessions ended; and 𝛽3represents the added impact of combining the cash 
and gPM+ treatment. 
References 
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