In what follows, we discuss the available empirical evidence for Pakistan on the effects of cash transfers, and nutrition services delivered through the public primary health system, on child nutrition status, or, absent which, on factors that are considered to be intermediate outcomes. An important caveat is that the evaluation designs of the studies differ in rigor. Hence, we describe the evaluation design when discussing each study’s findings. We begin the section by discussing government funding for nutrition-related programs, and end the section by discussing qualitative evidence on the factors associated with public primary health worker performance.

# A. _Government funding for nutrition-related programs_

Government funding for nutrition-related programs in Pakistan is relatively low. IFPRI (2016) reports that Pakistan allocates about 1% of its total budget toward nutrition-related programs, compared to an average of 2% for a sample of 24 developing countries. The share of the country’s budgetary allocation toward nutrition-specific programs (programs that directly target the immediate determinants of undernutrition) is 35%.

Fracassi et al. (2015) review the government budget for nutrition-related programs in Pakistan for 2014, along with those of several other developing countries. We report four findings from the study regarding the estimated maximum public budget for nutrition-related programs in Pakistan. First, the nutrition-related budget for 58 programs administered by 21 agencies is $9.3 per capita (in 2014 US dollars). Second, nutrition-sensitive programs (interventions that aim to address the underlying determinants of undernutrition) account for 81% of the nutrition-related budget. Among these programs, the Benazir Income Support Program (BISP), discussed in the next subsection, accounts for 56% of the nutrition-related budget. Third, with respect to the distribution across sectors, social protection has the largest nutrition-related budget in per capita terms ($5.3), followed, in decreasing order, by WASH ($1.8), health ($1.1), education ($0.7), and agriculture ($0.5). Fourth, with respect to the distribution across provinces, Punjab has the largest nutritionrelated budget in per capita terms ($5.1), followed, in decreasing order, by KPK ($0.9), Sindh ($0.6), and Balochistan ($0.2).

# B. _Cash transfers_

The international evidence on the effects of cash transfer programs on child nutrition status is mixed – the effects of programs vary based on program design, target population, program participation duration, setting, and evaluation method (Ruel et al. 2013). Manley, Gitter, and Slavchevska (2013) find in their meta-analysis that the average aggregate effect of cash transfer programs, both unconditional and conditional, on HAZ is positive but insignificant. While not always significant, they also find that average aggregate effects on HAZ are larger for girls and for the youngest children, for households with longer program participation, in settings with lower HAZ and health service use at baseline, and for programs with health-related conditions.

Pakistan has three main government cash transfer programs targeted at the poor: (1) the Guzara allowance, financed by Zakat contributions collected by the government; (2) the Pakistan Bait-ulMal, which was initiated in 1992 and targets specific poor groups, such as widows, orphans, the disabled, and the elderly; and (3) BISP, which was initiated in 2008 and is the largest social protection program in the country. Using 2013–14 data, GOP and WFP (2016) find that the average 24