"When They Are Ready, It Has to Be There": A Conversation with Jacob Novignon on Cash Transfers and Health

In this Q&A, health economist Jacob Novignon talks about the path that took him from mainstream economics into health economics, what PRESTO's evidence synthesis reveals about cash transfers and health, the stubborn myth about alcohol and tobacco, and why he believes the job of a researcher is to put the evidence where policymakers can find it.

The Researcher

Please tell us about yourself and your work with PRESTO.

My name is Jacob Novignon. People often stumble over the surname, so I like to explain it. It is French, but it is also Ghanaian. In Ghana we share a border with Togo, and beyond Togo is Benin, both francophone, and the Volta region of Ghana was essentially carved out of that same area by our colonial masters. So the name carries the same meaning across Ghana, Togo, and Benin. Literally, it means brother is good. It is good to have a brother.

By training I am an economist, through and through. My first degree, my master's, and my PhD are all in economics. I am also a typical Pan-African student, because I did all of my formal education on the continent: my undergraduate degree in Ghana, my master's in Malawi, and my PhD in Nigeria. That path was made possible by the African Economic Research Consortium, the AERC, which is also the institution we are collaborating with on this project¹. The AERC funds graduate training through a capacity-building model. It identifies universities that already have strong graduate training capacity, places students from institutions with less capacity into those schools, and trains them so they can return home and build capacity there. At the time, that took me to Malawi for my master's and later to Nigeria for my PhD. The AERC is enormously influential. There are very few economics departments in Africa where you will not find its trace.

I finished my PhD in 2015. For most of the past decade I was at the Kwame Nkrumah University of Science and Technology in Kumasi, and since the beginning of last year I have been at the University of Ghana in Accra, where I am a Senior Research Fellow in health economics at the Centre for Social Policy Studies.

My route to PRESTO runs through a mentorship. After my PhD, I chanced on a postdoctoral fellowship with the Transfer Project, and Tia became my mentor. The fellowship was only six months, but the mentorship carried on for almost four years, and in truth it continues today. We have published several papers together. So when Tia started PRESTO and asked whether I would be interested, my answer was, why not? Most recently, I worked on our evidence synthesis on cash transfers, where I led the health component, looking at how cash transfers affect different health outcomes.

Can you walk us through your background and what led you to the work you do today as a health economist?

I trained as an economist, but my research and career have veered into health economics, which sits at the intersection of health and economics. What drew me there, honestly, was that at the time it was new. When I told people I wanted to study health economics, the reaction was usually puzzlement: what does economics have to do with health? Is that not for doctors? That scepticism is exactly what pulled me in. If it is a new area and people do not really know what is there, I thought, then I should probably go in and find out, rather than doing the routine thing everyone expects an economist to do.

Once I was inside the field, I saw how important it was. Think of a mother who cannot reach a health facility to deliver her baby. The reason might be that she cannot afford it, or that the government does not have the means to provide the facility. That is economics. Look around, then and now, and it is a huge issue. Many people cannot get the healthcare they need, especially in remote areas, because they cannot afford it. So how can anyone ask what economics is doing here?

That settled it for me. I decided this is what I want to do for the rest of my life. If I put it simply, I want to do research that informs how policymakers can help people access healthcare without financial difficulty and without physical barriers. When people need care, it should be there.

Cash Transfers and Health

Last year at PRESTO you led an evidence summary on the impacts of cash transfers on health. Can you tell us about some general findings on this topic?

Cash transfers are huge in Africa. Governments are expanding these interventions, and others are keen to adopt them, so the evidence really matters. At the moment, Africa has the largest body of evidence on cash transfers, and this can be overwhelming for policy makers. The synthesis therefore helps both policy makers and their technical assistants to easily digest the evidence.

For the synthesis, I worked on the health components: how cash transfers affect different health outcomes. Honestly, many of the findings did not surprise me, because our earlier work had already identified the pathways. The evidence broadly confirmed that cash transfers influence how people use healthcare services, shape health-related behaviours, and affect health expenditure and financing within households. Pulling everything together consolidated those pathways and the relationships between them.

There is an often-repeated concern that if you give people cash transfers, they will spend it on alcohol and tobacco. What does the evidence say on this topic?

This was one of the more interesting findings. There is a persistent belief that if you give people cash, that is what they will spend it on: alcohol and tobacco. But there was no evidence for it. Absolutely none suggesting that cash transfers lead to increased spending or consumption of alcohol and tobacco. That myth simply did not hold up.

On Evidence Uptake

As an academic, you have published many peer-reviewed journal articles. In your opinion, why are evidence summaries like this, which are not intended for journals and have a different audience, important? What do you hope to achieve with this work?

I did not realise, early on, how satisfying it is to see work you did as an academic actually change something. Sometimes you do not even know it has happened. You find out later that someone says, oh, we made this policy, and we used a little of your evidence.

My view is that nobody expects you to go chasing policymakers with your findings. What you need to do is produce the evidence and put it out there, because when policymakers are ready and they want it, it has to be available. So do not be discouraged that policymakers are not taking up your evidence today. Produce it, put it out there, and when they are ready, they will find it, and they will use it. The end goal, for me, is to do research that is policy relevant, research that can shape people's lives.

“Just produce the evidence and put it out there. When they are ready, they will find it, and they will use it.”

There is a related point about communication. A large part of our population is uninformed about very basic things, and sometimes the level genuinely shocks you. As researchers, we have too often sat in what we call the citadel of knowledge: we generate knowledge and leave it there. We need to engage more. There are various means now, social media among them, and people who can take the evidence and turn it into something a layperson can read and relate to. Behind that simple message is often complex modelling, but the message still has to land. Those of us in mainstream economics are not naturally good at that, because our interest tends to be the model. It is a skill more researchers need to cultivate. Over lunch, Tia and I were actually discussing how to expand this work into media training: teaching researchers how to engage with journalists, how to approach interviews, how to prepare. It is something we have never really cared about, yet it is very important. And policymakers, of course, have a big role too, because ultimately they call the shots.

In Dakar, you presented at a workshop convened by the Transfer Project, a collaborative network between UNICEF, FAO, the University of North Carolina, and national governments that provides rigorous evidence on national cash transfer programmes to inform policy and programming. What was your impression of this event, which brought together government, researchers, and other stakeholders, and is there a conversation from it that stayed with you?

That was very early in my career, just after my fellowship, when I was invited to attend. What struck me most was the engagement with policymakers. You bring academics doing rigorous research into the same room as the people who sit in ministries and have direct control over policy, and then you have to get your message across to them.

The lesson that has stayed with me is about how you carve your message out of all the research you have done. I had sent Tia my presentation beforehand. I thought it was very good: all my methodology, all the rigorous detail. She looked at it and said, we need to redo this. And she was right. If I had presented it as it was, I would have left the whole room confused, because a policymaker would not follow it. Presenting to your colleagues is a different thing entirely. So I learned a big lesson: understand which audience you are sharing your research with, craft your message to suit that audience, and prepare your slides to communicate that message clearly. Too often our slides are bulky and text-heavy, and the main messages are not clear. That has stuck with me for a very long time.

Off the clock

What do you like to do when you are not working?

I am a music lover. I used to tell my friends that if I were not in academia, I would probably be producing music, which is quite a different trajectory. I grew up as an instrumentalist and started on the bass guitar, an instrument I still love, though I rarely have the time to play these days. When I do have the time, I like to. I do not collect music, but I listen and appreciate it, and I would say my appreciation runs a little above the average listener.

My genre is Afrobeats. The Nigerians dominate, of course, with names that are easy to mention, like Burna Boy, Wizkid, and Davido, all doing great things. But let me take you back home to Ghana, to Stonebwoy. He does a style he calls Afro Dancehall. Look him up on any streaming app, and listen to his song "Run go." He put real thought into it. It talks about politics in Africa, and it advises politicians to understand that we have nowhere else to go. We have one country, and it is all we have, so they should work towards building it.

¹Jacob is referring to the AERC impact evaluation retooling workshop for teaching faculty in Africa, where Jacob and PRESTO’s Tia Palermo were co-instructors in Nairobi in July 2026. You can learn more about it here: link

Keep reading

• Explore PRESTO's related work on our Projects page.

• Read the cash transfers and health evidence synthesis.

About Jacob

Jacob Novignon is a health economist and senior research fellow at the University of Ghana's Centre for Social Policy Studies in Accra. An economist by training, he holds his first degree, master's, and PhD in economics, completing all of his formal education on the African continent with support from the African Economic Research Consortium (AERC). He earned his PhD in 2015 and spent much of the following decade at the Kwame Nkrumah University of Science and Technology in Kumasi before moving to the University of Ghana. His work focuses on health economics and healthcare access, particularly how households and governments finance and reach the care people need. He first connected with PRESTO through a postdoctoral fellowship with the Transfer Project, and most recently led the health component of PRESTO's evidence synthesis on cash transfers.