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Performance-Based Incentives for Health: Conditional Cash Transfer Programs in Latin America and the Caribbean

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Author Info

  • Amanda Glassman
  • Jessica Todd

Abstract

In order to support poor families in the developing world to seek and use health care, a multi-pronged strategy is needed on both the supply and the demand side of health care. A demand-side program called Conditional Cash Transfers (CCTs) strives to reduce poverty and also increase food consumption, school attendance, and use of preventive health care. Since 1997, seven countries in Latin America have implemented and evaluated CCT programs with health and nutrition components. The core of the program is based on encouraging poor mothers to seek preventive health services and attend health education talks by providing a cash incentive for their healthy behavior (with healthy behavior representing performance). Evaluations of these programs measured outputs in the utilization of services; health knowledge, attitudes, and practice; food consumption; the supply and quality of services; as well as outcomes in vaccination rates; nutritional status; morbidity; mortality; and fertility. While CCT impact evaluations provided unambiguous evidence that financial incentives increase utilization of key services by the poor, the studies gave little attention to the impact on health-related behaviors, attitudes, and household decision-making or how these factors contribute to or limit impact on health outcomes. Recommendations include expanding the scope of future evaluations to study these effects, modeling program effects beforehand, and carefully selecting the conditions for payment so that they are not too burdensome yet not irrelevant. Continuing to focus on the extreme poor is recommended since findings show that the poorest households must reach a minimum level of food consumption before they are able to make other investments in their health and well-being.

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File URL: http://www.cgdev.org/files/13542_file_CCT_LatinAmerica.pdf
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Bibliographic Info

Paper provided by Center for Global Development in its series Working Papers with number 120.

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Length: 59 pages
Date of creation: Apr 2007
Date of revision:
Handle: RePEc:cgd:wpaper:120

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Web page: http://www.cgdev.org

Related research

Keywords: Health; Latin America; Caribbean;

This paper has been announced in the following NEP Reports:

References

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  1. Rawlings, Laura B. & Rubio, Gloria M., 2003. "Evaluating the impact of conditional cash transfer programs : lessons from Latin America," Policy Research Working Paper Series 3119, The World Bank.
  2. Katherin Ross Phillips & Paul Gertler & Timothy M. Smeeding & Orazio P. Attanasio & Manfred Zeller & Hugo A. Hopenhayn & Estelle James & José-Victor Ríos-Rull & Steen Lau Jørgensen & Nora Lustig & , . "Shielding the Poor: Social Protection in the Developing World," IDB Publications 50878, Inter-American Development Bank.
  3. Schultz, T. Paul, 2001. "School subsidies for the poor," FCND discussion papers 102, International Food Policy Research Institute (IFPRI).
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  6. Jere R. Behrman & John Hoddinott, 2005. "Programme Evaluation with Unobserved Heterogeneity and Selective Implementation: The Mexican "PROGRESA" Impact on Child Nutrition," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 67(4), pages 547-569, 08.
  7. Heinrich, Carolyn J., 2007. "Demand and Supply-Side Determinants of Conditional Cash Transfer Program Effectiveness," World Development, Elsevier, vol. 35(1), pages 121-143, January.
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  11. François Bourguignon & Francisco H. G. Ferreira & Phillippe G. Leite, 2002. "Ex-ante Evaluation of Conditional Cash Transfer Programs: The Case of Bolsa Escola," William Davidson Institute Working Papers Series 516, William Davidson Institute at the University of Michigan.
  12. Hoddinott, John & Skoufias, Emmanuel, 2004. "The Impact of PROGRESA on Food Consumption," Economic Development and Cultural Change, University of Chicago Press, vol. 53(1), pages 37-61, October.
  13. Schady, Norbert & Araujo, Maria Caridad, 2006. "Cash transfers, conditions, school enrollment, and child work : evidence from a randomized experiment in Ecuador," Policy Research Working Paper Series 3930, The World Bank.
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  17. Behrman, Jere R. & Deolalikar, Anil B., 1988. "Health and nutrition," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 1, chapter 14, pages 631-711 Elsevier.
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  19. Coady, David P. & Parker, Susan W., 2002. "A cost-effectiveness analysis of demand- and supply-side education interventions," FCND discussion papers 127, International Food Policy Research Institute (IFPRI).
  20. Guy Stecklov & Paul Winters & Jessica Todd & Ferdinando Regalia, 2006. "Demographic Externalities from Poverty Programs in Developing Countries: Experimental Evidence from Latin America," Working Papers 2006-01, American University, Department of Economics.
  21. Carolyn Heinrich, 2005. "Demand and Supply-Side Determinants of Conditional Cash Transfer Program Effectiveness: Improving the First-Generation Programs," IDB Publications 25858, Inter-American Development Bank.
  22. Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
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Citations

Blog mentions

As found by EconAcademics.org, the blog aggregator for Economics research:
  1. Six Ideas and Questions for GAVIâ??s New CEO
    by Amanda Glassman in Global Health Policy on 2011-03-09 16:46:12
  2. Food Prices, Health, and Nutrition: Focus on the Poor Now!
    by Amanda Glassman in Global Health Policy on 2011-02-10 20:25:31
  3. Six Ideas and Questions for GAVI’s New CEO
    by Amanda Glassman in Global Health Policy on 2011-03-09 16:46:12
Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
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Cited by:
  1. Gentilini, Ugo & Omamo, Steven Were, 2011. "Social protection 2.0: Exploring issues, evidence and debates in a globalizing world," Food Policy, Elsevier, vol. 36(3), pages 329-340, June.
  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. Guisan, M.C. & Aguayo, E., 2007. "Health Expenditure, Poverty and Economic Development in Latin America 2000-2005," International Journal of Applied Econometrics and Quantitative Studies, Euro-American Association of Economic Development, vol. 4(2), pages 5-24.

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