In the light of chronic poverty, food insecurity and increasing HIV and AIDS in east and southern Africa, there is a growing recognition by policy-makers and practitioners of the importance of cash transfers for reaching vulnerable children and households.This report documents the use of unconditional cash transfers in the region and the lessons learned from selected schemes in Ethiopia, Lesotho, Mozambique and Zambia. It explores the ways children, their carers and families benefit from the transfers, and considers different design, implementation and management issues. Given the scale of the challenges ahead for east and southern Africa, the report calls for a significant shift in approach towards regular, predictable, cash-based support that reaches the poorest.