Cash transfers are great – lots of people are telling you that on a continuous basis. However, it is an open question as to whether such programs can improve the wellbeing of their beneficiaries well after the cessation of support. As cash transfer programs continue to grow as major vehicles for social protection, it is increasingly important to understand if these programs break the cycle of intergenerational poverty, or whether the benefits simply evaporate when the money runs out…
conditional cash transfers
A blogpost on financial incentives in health by one of us in September 2015 generated considerable interest. The post raised several issues, one being whether demand-side financial incentives (like maternal vouchers) are more or less effective at increasing the uptake of key maternal and child health (MCH) interventions than supply-side financial incentives (variously called pay-for-performance (P4P) or performance-based financing (PBF)).
The four of us are now hard at work investigating this question — and related ones — in a much more systematic fashion. And we'd very much welcome your help.
This post was co-authored with Katrina Kosec of IFPRI.
A whirlwind, surely incomplete tour of cash transfer impacts on health
Your run-of-the-mill conditional cash transfer (CCT) program has significant impacts on health-seeking behavior. Specifically, there are conditions (or co-responsibilities, if you prefer) that children get to school and/or that they get vaccinated or have some wellness visits. While the school enrollment effects are well established, the effects on both health seeking behavior and on health outcomes have been much more mixed. CCTs have led to better child nutritional status and improved child cognitive development in Nicaragua, better nutritional outcomes for a subset of children in Colombia, and had no impacts for child health in studies on Brazil and Honduras. CCTs conditioned only on school enrollment did not lower HIV infections among adolescent girls in South Africa; and in Indonesia CCTs increased health visits but did not translate into measurably improved health. Unconditional cash transfer programs have also had mixed results on health, with better mental health and food consumption in Kenya, better anthropometric outcomes for girls (not boys) in South Africa, no average impacts (although some for the poorest quarter) on child outcomes in Ecuador, and no average impacts on maternal health care utilization in Zambia (albeit yes effects for women with better access to such services).
On September 30, the Guardian ran several articles (see here, here, and an editorial here) linking the halving of Peru’s stunting rate (from 28 to 14% between mid-2000s and 2015) to its CCT program Juntos. Of course, it is great to hear that the share of stunted children in Peru declined dramatically over a short period. However, as I know that while CCT programs (conditional or not) have been successful in improving various outcomes including child health, the effect sizes are never this dramatic, I was curious to see whether the decline was part of a secular trend in Peru or actually could be attributed primarily to Juntos…
When I was a high school student in Belgium, our history textbook included a reproduction of a painting entitled “The Drunkard” by Eugène Laermans. The painting was included in the section describing the history of the labor movement in the country and its achievements in passing legislation aimed at improving the situation of the working class. In particular, the painting was meant to illustrate why the Belgian law introducing child benefits – monthly transfers to all families raising children until age 18 (or until age 25 as long as they are still students) - stipulates that these benefits are paid to the mother. The law still holds today, even if it allows for exceptions when the mother is not present in the household.
Vote buying has shaped much of Philippine politics throughout history. For many politicians, distributing private goods and cultivating patronage to individual supporters is one of the most effective electoral strategies.
While the line between public and private is traditionally blurry, people who are used to this relationship with those who hold positions in government tend to measure politicians’ performance in terms of how much they provide private goods as opposed to broad public goods.
But though it may have been prevalent, vote buying has been a serious constraint in the country. Research has shown that practices such as vote buying and political dynasties undermine public service delivery and poverty reduction. How can these practices, which are so deeply embedded in Filipinos’ political way of life, begin to change?
It is 8 AM. The winter sun begins to appear over the gray-green mass of trees above the village of Tritriva in Madagascar’s central highlands. The courtyard of a stone church is already filled with women, many holding still-sleeping children in their arms. They have assembled for the first time in two months to receive a cash payment from the Malagasy state.
The women are poor and all live on less than $2 per day. The money they receive from the government amounts to about a third of their cash income for the two months in between each payment: it will go a long way in helping them support their families for the rest of the winter.
Initiated by the Madagascar government, with support from the World Bank, the payments are part of a new program implemented by the Fonds d'Intervention pour le Développement (FID) to combat poverty in rural Madagascar and provide sustainable pathways to human development.
Unprecedented economic growth in the last three decades propelled East Asia into an economic powerhouse responsible for a quarter of the world’s economy.
Hundreds of millions of people across the region, including in China, Indonesia, Malaysia, Thailand and Vietnam, lifted themselves out of extreme poverty and enjoyed greater prosperity, largely because of more labor-intensive and inclusive growth.
The success didn’t come without challenges. As of last year, 100 million people in East Asia still live on $1.25 a day. About 260 million still live on $2 a day or less, and they could fall back into poverty if the global economy takes a turn for the worse or if they face health, food and other shocks at home. Their uncertain future shows the increasing inequality of East Asia’s galloping growth.
This post is jountly authored by Martina Björkman Nyqvist, Lucia Corno, Damien de Walque and Jakob Svensson.
Conditional cash transfers (CCTs) and other types of financial incentives have been used successfully to promote activities that are beneficial to the participants such as school attendance and health check-ups for children. CCTs pay a certain amount if the condition is verified.
Lotteries can also be used as an incentive. Instead of being paid a certain amount, the participants who satisfy the condition receive a lottery ticket, a random draw is performed among the tickets, and a predetermined number of winners earn a lottery prize. The value of the lottery prizes would be higher than the typical CCT amount, but the number of recipients of the prizes would be lower.
As many middle-income countries are moving towards embracing cash transfers with or without co-responsibilities attached (and the recent hype of handing cash directly to the poor), there is an important wave of programs that provide “cash plus” intervention.