Performance-Based Incentives for Health: Conditional Cash Transfer Programs in Latin America and the Caribbean
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.
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- David Coady & Margaret Grosh & John Hoddinott, 2004. "Targeting of Transfers in Developing Countries : Review of Lessons and Experience," World Bank Publications, The World Bank, number 14902.
- 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.
- Bourguignon, Francois & Ferreira, Francisco H. G. & Leite, Phillippe G., 2002. "Ex-ante evaluation of conditional cash transfer programs: the case of bolsa escola," Policy Research Working Paper Series 2916, The World Bank.
- Maluccio, John A. & Flores, Rafael, 2004.
"Impact evaluation of a conditional cash transfer program,"
184, International Food Policy Research Institute (IFPRI).
- Maluccio, John A. & Flores, Rafael, 2004. "Impact evaluation of a conditional cash transfer program," FCND discussion papers 184, International Food Policy Research Institute (IFPRI).
- Handa, Sudhanshu & Huerta, Mari-Carmen & Perez, Raul & Straffon, Beatriz, 2001. "Poverty, inequality, and spillover in Mexico's education, health, and nutrition program," FCND discussion papers 101, International Food Policy Research Institute (IFPRI).
- Dan Levy Jim Ohls, 2007. "Findings from the Impact Evaluation of Jamaicas PATH Programme," Mathematica Policy Research Reports 3fbf7421a86d498083e341502, Mathematica Policy Research.
- 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.
- 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 & Eli, 2001. "Shielding the Poor: Social Protection in the Developing World," IDB Publications (Books), Inter-American Development Bank, number 50878 edited by Nora Lustig, October.
- 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.
- 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.
- 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).
- Coady, David P. & Parker, Susan W., 2002. "A cost-effectiveness analysis of demand- and supply-side education interventions," FCND briefs 127, International Food Policy Research Institute (IFPRI).
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- Hoddinott, John & Skoufias, Emmanual, 2003.
"The impact of Progresa on food consumption,"
150, International Food Policy Research Institute (IFPRI).
- Handa, Sudhanshu, 2002. "Raising primary school enrolment in developing countries: The relative importance of supply and demand," Journal of Development Economics, Elsevier, vol. 69(1), pages 103-128, October.
- Schultz, T. Paul, 2001.
"School subsidies for the poor,"
FCND discussion papers
102, International Food Policy Research Institute (IFPRI).
- 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).
- 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.
- T. Paul Schultz, 2001. "School Subsidies for the Poor: Evaluating the Mexican Progresa Poverty Program," Working Papers 834, Economic Growth Center, Yale University.
- 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.
- 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.
- Dan Levy & Jim Ohls, 2007. "Evaluation of Jamaicas PATH Program," Mathematica Policy Research Reports a966b4fee12348a99371de277, Mathematica Policy Research.
- Carolyn Heinrich, 2005. "Demand and Supply-Side Determinants of Conditional Cash Transfer Program Effectiveness: Improving the First-Generation Programs," IDB Publications (Working Papers) 25858, Inter-American Development Bank.
- repec:idb:brikps:50878 is not listed on IDEAS
- 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.
- Handa, Sudhanshu & Huerta, Mari-Carmen & Perez, Raul & Straffon, Beatriz, 2001. "Poverty, inequality, and spillover in Mexico's education, health, and nutrition program," FCND briefs 101, International Food Policy Research Institute (IFPRI).
- Behrman, Jere R & Sengupta, Piyali & Todd, Petra, 2005. "Progressing through PROGRESA: An Impact Assessment of a School Subsidy Experiment in Rural Mexico," Economic Development and Cultural Change, University of Chicago Press, vol. 54(1), pages 237-75, October.
- Selma J. Mushkin, 1962. "Health as an Investment," Journal of Political Economy, University of Chicago Press, vol. 70, pages 129.
When requesting a correction, please mention this item's handle: RePEc:cgd:wpaper:120. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (David Roodman)The email address of this maintainer does not seem to be valid anymore. Please ask David Roodman to update the entry or send us the correct address
If references are entirely missing, you can add them using this form.