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Conditional cash transfers and health: unpacking the causal chain


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  • Marie Gaarder
  • Amanda Glassman
  • Jessica Todd


This paper investigates whether conditional cash transfer (CCT) programmes that include health and nutrition components improve health and nutritional outcomes, and if so, which components of the programmes, or combination thereof, are important in achieving these improvements. Using evidence from Latin America, Africa, Asia and the Middle East, the paper adopts a theory-based approach that spells out the assumptions behind the expectation that the CCT interventions will have a measurable impact on health and nutrition outcomes. CCT impact evaluations provide unambiguous evidence that financial incentives work to increase utilisation of those key health services by the poor upon which the cash transfer is conditioned, if the beneficiaries have knowledge of this condition. However, results are mixed with respect to nutrition and health outcomes, suggesting that encouraging utilisation when the pertinence of services is unknown or of poor quality may not produce the expected effects. Incipient results from Mexico indicate, however, that service quality is not necessarily exogenous to the programme, but may be positively affected by giving the poor women skills, information, and social support to negotiate better care from healthcare providers. Findings from Mexico indicate that there are direct routes by which the cash transfers affect health, outside of the health sector interactions. In particular, the poverty alleviation achieved with the cash transfers may affect the mental health of beneficiaries, as well as their lifestyle choices. The main policy recommendation that ensues from this review is the need to find the right mix of incentives and regulation to improve the quality of care, while at the same time investing in the empowerment of users. Future research that explores the relative cost-effectiveness of investing in the supply versus the demand-side within the health system will be crucial, along with further research on the need for conditionalities. Other areas that could benefit from further evidence include morbidity outcomes from programmes other than Oportunidades, including mental health and chronic disease, impacts on health-related behaviours and attitudes, and how these factors affect outcomes, and the effects on out-of-pocket expenditure.

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Bibliographic Info

Article provided by Taylor & Francis Journals in its journal Journal of Development Effectiveness.

Volume (Year): 2 (2010)
Issue (Month): 1 ()
Pages: 6-50

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Handle: RePEc:taf:jdevef:v:2:y:2010:i:1:p:6-50

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Keywords: conditional cash transfer interventions; theory-based approach; health and nutritional outcomes;


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Cited by:
  1. Miguel Szekely, 2011. "Toward Results-Based Social Policy Design and Implementation - Working Paper 249," Working Papers 249, Center for Global Development.
  2. van den Bold, Mara & Quisumbing, Agnes R. & Gillespie, Stuart, 2013. "Women’s empowerment and nutrition: An evidence review:," IFPRI discussion papers 1294, International Food Policy Research Institute (IFPRI).
  3. Scarlato, Margherita, 2012. "Social Enterprise, Capabilities and Development: Lessons from Ecuador," MPRA Paper 37618, University Library of Munich, Germany.
  4. Manley, James & Gitter, Seth & Slavchevska, Vanya, 2013. "How Effective are Cash Transfers at Improving Nutritional Status?," World Development, Elsevier, vol. 48(C), pages 133-155.
  5. repec:fpr:export:1342 is not listed on IDEAS
  6. Alderman, Harold, 2014. "Can transfer programs be made more nutrition sensitive?:," IFPRI discussion papers 1342, International Food Policy Research Institute (IFPRI).
  7. Escobal, Javier & Benites, Sara, 2012. "Algunos impactos del programa JUNTOS en el bienestar de los niños: Evidencia basada en el estudio Niños del Milenio
    [Impacts of the Conditional Cash Transfer programme JUNTOS for children in Peru
    ," MPRA Paper 56480, University Library of Munich, Germany.
  8. Limodio, Nicola, 2011. "The impact of pro-vulnerable income transfers : Leisure, dependency and a distribution hypothesis," Policy Research Working Paper Series 5881, The World Bank.


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