The Cacao Effect Program and its Resilience Component on San Andrés de Tumaco, Colombia: An Ecological Study on Violence and Economic Outcomes

The Cacao Effect Program (TCE), launched in 2015 in Nariño, Colombia, and its "Conmigo, Contigo, Con todo (3C)" component introduced in 2021 in San Andrés de Tumaco, aim to improve living conditions and the cacao production chain while enhancing resilience and psychosocial support among producers amidst armed conflict, displacement, and illicit activities. We aim to evaluate the association between The Cacao Effect Program and its 3C component (TCE-3C) and population outcomes related to mortality, violence, and productivity in the cacao sector in San Andrés de Tumaco.

A retrospective observational study spanning from 2015 to 2022 assessed the entire population of San Andrés de Tumaco. Utilizing a before-and-after design with a control group, the study employed difference-in-differences (DiD) analysis at individual and municipal levels to examine the association of TCE-3C with mortality, violent deaths, armed conflict events, and cacao sector productivity indicators. Data sources included the Unique Health System Enrollment Database, death certificates, vital statistics, and National Federation of Cacao Farmers reports.

Post-intervention analysis indicates a reduction in the risk of mortality from general causes and violent deaths in San Andrés de Tumaco compared to the rest of Colombia. Additionally, there was a notable decrease in armed conflict events and a significant increase in cocoa sector productivity regarding hectares harvested and production tonnage post-EC-3C implementation.

The findings suggest a positive ecological association between the TCE-3C program's implementation and mortality rate improvements, violence reduction, and enhanced productivity within the cacao sector. Although causality cannot be established due to the study's ecological design, the results support the potential effectiveness of comprehensive, community-based psychosocial interventions in conflict-affected regions. Future research should employ longitudinal and experimental designs to elucidate further these associations and the mechanisms underlying the observed outcomes.