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Conditional cash transfers and health: unpacking the causal chain

Author

Listed:
  • Marie Gaarder
  • Amanda Glassman
  • Jessica Todd

Abstract

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.

Suggested Citation

  • Marie Gaarder & Amanda Glassman & Jessica Todd, 2010. "Conditional cash transfers and health: unpacking the causal chain," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(1), pages 6-50.
  • Handle: RePEc:taf:jdevef:v:2:y:2010:i:1:p:6-50
    DOI: 10.1080/19439341003646188
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    References listed on IDEAS

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    1. Jorge M. Aguero & Michael R. Carter & Ingrid Woolard, 2006. "The Impact of Unconditional Cash Transfers on Nutrition: The South African Child Support Grant," SALDRU Working Papers 8, Southern Africa Labour and Development Research Unit, University of Cape Town.
    2. World Bank, 2006. "Repositioning Nutrition as Central to Development : A Strategy for Large Scale Action," World Bank Publications, The World Bank, number 7409.
    3. 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).
    4. repec:mpr:mprres:5391 is not listed on IDEAS
    5. Paxson, Christina & Schady, Norbert, 2007. "Does money matter ? The effects of cash transfers on child health and development in rural Ecuador," Policy Research Working Paper Series 4226, The World Bank.
    6. 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.
    7. Benjamin Davis & Sudhanshu Handa & Marta Ruiz-Arranz & Marco Stampini & Paul Winters, 2002. "Conditionality and the Impact of Programme Design on Household welfare: Comparing two diverse cash transfer programmes in rural Mexico," Working Papers 02-10, Agricultural and Development Economics Division of the Food and Agriculture Organization of the United Nations (FAO - ESA).
    8. Behrman, Jere R. & Hoddinott, John, 2001. "An evaluation of the impact of PROGRESA on pre-school child height," FCND briefs 104, International Food Policy Research Institute (IFPRI).
    9. Fabio Veras Soares & Rafael Perez Ribas & Guilherme Issamu Hirata, 2008. "Achievements and Shortfalls of Conditional Cash Transfers: Impact Evaluation of Paraguay?s Tekoporã Programme," Publications 3, International Policy Centre for Inclusive Growth.
    10. repec:mpr:mprres:7336 is not listed on IDEAS
    11. Marta Ruiz-Arranz & Benjamin Davis & Marco Stampini & Paul Winters & Sudhanshu Handa, 2002. "More Calories or More Diversity? An econometric evaluation of the impact of the PROGRESA and PROCAMPO transfer programmes on food security in rural Mexico," Working Papers 02-09, Agricultural and Development Economics Division of the Food and Agriculture Organization of the United Nations (FAO - ESA).
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    Citations

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    Cited by:

    1. Luis García & Erika Collantes, 2017. " Impacto del programa social Juntos sobre la oferta laboral femenina en el Perú [Effect of the Juntos social program on female labor supply in Peru]," Documentos de Trabajo / Working Papers 2017-448, Departamento de Economía - Pontificia Universidad Católica del Perú.
    2. Ebenezer Owusu-Addo & Ruth Cross, 2014. "The impact of conditional cash transfers on child health in low- and middle-income countries: a systematic review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(4), pages 609-618, August.
    3. 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.
    4. Tagel Gebrehiwot & Carolina Castilla, 2018. "Do safety net transfers improve household diets and reduce undernutrition? Evidence from rural Ethiopia," Working Papers PMMA 2018-03, PEP-PMMA.
    5. Naila Kabeer & Hugh Waddington, 2015. "Economic impacts of conditional cash transfer programmes: a systematic review and meta-analysis," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 7(3), pages 290-303, September.
    6. Zulkhibri, Muhamed, 2016. "Conditional Cash Transfers in Developing Economy: The Case of Muslim Countries," Working Papers 2016-6, The Islamic Research and Teaching Institute (IRTI).
    7. Teresa Molina-Millan & Tania Barham & Karen Macours & John A. Maluccio & Marco Stampini, 2016. "Long-term Impacts of Conditional Cash Transfers in Latin America: Review of the Evidence," IDB Publications (Working Papers) 7891, Inter-American Development Bank.
    8. repec:bla:devpol:v:35:y:2017:i:5:p:621-643 is not listed on IDEAS
    9. Teresa Molina-Millan & Tania Barham & Karen Macours & John A. Maluccio & Marco Stampini, 2016. "Long-term Impacts of Conditional Cash Transfers in Latin America: Review of the Evidence," IDB Publications (Working Papers) 96136, Inter-American Development Bank.
    10. Alderman, Harold, 2014. "Can transfer programs be made more nutrition sensitive?:," IFPRI discussion papers 1342, International Food Policy Research Institute (IFPRI).
    11. repec:fpr:export:1342 is not listed on IDEAS
    12. 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.
    13. Scarlato, Margherita, 2012. "Social Enterprise, Capabilities and Development: Lessons from Ecuador," MPRA Paper 37618, University Library of Munich, Germany.
    14. Miguel Szekely, 2011. "Toward Results-Based Social Policy Design and Implementation - Working Paper 249," Working Papers 249, Center for Global Development.
    15. 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).
    16. Verónica Amarante & Martí­n Brun, 2016. "Cash transfers in Latin America: Effects on poverty and redistribution," WIDER Working Paper Series 136, World Institute for Development Economic Research (UNU-WIDER).
    17. 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.
    18. repec:eee:wdevel:v:99:y:2017:i:c:p:498-517 is not listed on IDEAS
    19. Fiorella Benedetti & Pablo Ibarrarán & Patrick J. McEwan, 2016. "Do Education and Health Conditions Matter in a Large Cash Transfer? Evidence from a Honduran Experiment," Economic Development and Cultural Change, University of Chicago Press, vol. 64(4), pages 759-793.
    20. Victoria Menil, 2015. "Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs," Working Papers id:7987, eSocialSciences.

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