Effectiveness and implementation of “Graduation Approach” livelihood programs with displaced populations: A systematic review

Humanitarian actors have widely adopted “Graduation model” interventions to support sustainable livelihood development in displaced populations. We conducted a systematic review to evaluate existing evidence regarding Graduation model effectiveness and implementation factors in displacement contexts. We reviewed studies from grey and peer-reviewed literature, published from 2002-2024, describing Graduation model interventions among displaced adult populations. We searched eight databases (EconLit, Academic Search Ultimate, Family & Society Studies Worldwide, APA PsycINFO, PubMed, Web of Science, Global Health, and the Cochrane Library; updated October 2024) and 11 implementing agencies’ websites (updated April 2024). We assessed study quality using the Mixed Methods Appraisal Tool for systematic mixed-studies reviews. We screened all articles, reviewed full-text studies, and assessed record quality before narratively synthesizing findings. Of 575 screened records, five met inclusion criteria (total N = 28,873 participants). Studies included randomized and non-randomized trials, qualitative studies, and program reports conducted in Uganda, Mozambique, Colombia, and Costa Rica. Studies reported general improvements in participants’ food security and living conditions but rarely quantified these changes. Few employment outcomes were reported. Social wellbeing, mental health, and poverty outcomes were heterogeneous or unclear. Dependency on humanitarian aid was not directly assessed. Implementation barriers and facilitators were complex and context-specific, but comprehensive community-level support appeared central to program success. Program feasibility was best supported by flexible implementation, while sustainability was sensitive to factors such as land tenure and market inter-reliance. Reviewed studies provided insufficient detail to fully assess their quality or risk of bias. Substantial measurement heterogeneity precluded quantitative comparisons or meta-analysis. Despite the studies’ positive stated conclusions, we found limited implementation insights and little robust evidence of program effectiveness in displacement settings. Future research should address counterfactuals, long-term outcomes, and implementation issues to evaluate Graduation program effectiveness and sustainability in contemporary displacement contexts. Review protocol: PROSPERO CRD42023387899 (May 2023).Author summary: The “Graduation model” is a well-regarded program to help families in poverty develop sustainable livelihoods, but little is known about how well this model may work among communities who have fled violence, disaster, or threat and resettled in a new location. We reviewed and compiled all existing evidence about Graduation programs in displaced communities from academic articles and non-academic reports. We found five studies about such programs that provided limited details about how programs were conducted, how effective they were, and how they might need to change to better suit the unique challenges that displaced communities face. Factors that helped or hindered the program were complex, and suggested that community support on many levels is important for participants to thrive. The programs were best implemented when their approaches were flexible enough to adapt to urgent and changing needs, while their long-term sustainability depended on participants’ access to land and business markets. We found little existing high-quality evidence about these programs’ effectiveness or implementation with displaced communities, suggesting that additional research is needed to ensure these poverty alleviation efforts can sustainably meet the needs of displaced communities.