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Understanding use of health services in conditional cash transfer programs: Insights from qualitative research in Latin America and Turkey


  • Adato, Michelle
  • Roopnaraine, Terry
  • Becker, Elisabeth


Conditional cash transfer programs provide cash grants to poor households conditional on their participation in primary health care services. While significant impacts have been demonstrated quantitatively, little attention is paid to why CCTs have these observed impacts, and as importantly-- why impacts are not greater than they are. This article draws on qualitative research from four countries over a ten year period (1999-2009) to provide insights into why expected health and nutrition impacts do and do not occur. In Nicaragua, El Salvador, and Turkey, ethnographic methods were used, involving between 87 and 120 households per country, and in Mexico, focus groups were conducted with 230 people. Key informant interviews were conducted with health care providers in all countries. While CCTs operate primarily on the assumption that a cash incentive will produce behaviour change, we found multiple sociocultural and structural influences on health care decisions that compete with cash. These include beliefs around traditional and modern biomedical practices, sociocultural norms, gender relations, and the quotidian experience of poverty in many dimensions. We conclude that impacts can be increased through a better understanding of multiple contextual influences on health care decisions, and greater attention to the health education components and complementary interventions.

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  • Adato, Michelle & Roopnaraine, Terry & Becker, Elisabeth, 2011. "Understanding use of health services in conditional cash transfer programs: Insights from qualitative research in Latin America and Turkey," Social Science & Medicine, Elsevier, vol. 72(12), pages 1921-1929, June.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:12:p:1921-1929

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    References listed on IDEAS

    1. Finkler, Kaja, 2004. "Biomedicine globalized and localized: western medical practices in an outpatient clinic of a Mexican hospital," Social Science & Medicine, Elsevier, vol. 59(10), pages 2037-2051, November.
    2. van der Geest, Sjaak & Finkler, Kaja, 2004. "Hospital ethnography: introduction," Social Science & Medicine, Elsevier, vol. 59(10), pages 1995-2001, November.
    3. Smith-Oka, Vania, 2009. "Unintended consequences: Exploring the tensions between development programs and indigenous women in Mexico in the context of reproductive health," Social Science & Medicine, Elsevier, vol. 68(11), pages 2069-2077, June.
    4. Maluccio, John A. & Flores, Rafael, 2005. "Impact evaluation of a conditional cash transfer program: the Nicaraguan Red de Protección Social," Research reports 141, International Food Policy Research Institute (IFPRI).
    5. Ariel Fiszbein & Norbert Schady & Francisco H.G. Ferreira & Margaret Grosh & Niall Keleher & Pedro Olinto & Emmanuel Skoufias, 2009. "Conditional Cash Transfers : Reducing Present and Future Poverty," World Bank Publications, The World Bank, number 2597.
    6. Skoufias, Emmanuel, 2005. "PROGRESA and its impacts on the welfare of rural households in Mexico:," Research reports 139, International Food Policy Research Institute (IFPRI).
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    Cited by:

    1. Joshi, Shareen & Sivaram, Anusuya, 2014. "Does it Pay to Deliver? An Evaluation of India’s Safe Motherhood Program," World Development, Elsevier, vol. 64(C), pages 434-447.
    2. repec:eee:wdevel:v:99:y:2017:i:c:p:498-517 is not listed on IDEAS
    3. Julia Behrman, 2015. "Do Targeted Stipend Programs Reduce Gender and Socioeconomic Inequalities in Schooling Attainment? Insights From Rural Bangladesh," Demography, Springer;Population Association of America (PAA), vol. 52(6), pages 1917-1927, December.
    4. repec:eee:wdevel:v:98:y:2017:i:c:p:497-505 is not listed on IDEAS


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