Cash transfers

Abstract: Conditional cash transfers (CCTs) are programs that transfer cash, generally to poor households, on the condition that those households make pre specified investments in the human capital of their children. The report shows that there is good evidence that CCTs have improved the lives of poor people. Transfers generally have been well targeted to poor households, have raised consumption levels, and have reduced poverty, by a substantial amount in some countries. Offsetting adjustments that could have blunted the impact of transfers, such as reductions in the labor market participation of beneficiaries, have been relatively modest. The report also considers the rationale for conditioning the transfers on the use of specific health and education services by program beneficiaries. Thus CCTs have increased the likelihood that households will take their children for preventive health checkups, but that has not always led to better child nutritional status; school enrollment rates have increased substantially among program beneficiaries, but there is little evidence of improvements in learning outcomes. These findings suggest that to maximize their potential effects on the accumulation of human capital, CCTs should be combined with other programs to improve the quality of the supply of health and education services, and should provide other supporting services.

Abstract: People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

Abstract: We examine the social pension in South Africa, where large cash sums-about twice the median per capita income of African households-are paid to people qualified by age but irrespective of previous contributions. We present the history of the scheme and use a 1993 nationally representative survey to investigate the redistributive consequences of the transfers, documenting who receive the pensions, their levels of living, and those of their families. We also look at behavioural effects, particularly the effects of the cash receipts on the allocation of income to food, schooling, transfers, and savings. In South Africa, a large 'social pension'-about twice the median per capita income of African households-is paid in cash to people qualified by age irrespective of previous contributions. We present the history of the scheme and explain how such large transfers could come about in an economy in which the recipients were not only politically weak, but without any political representation whatsoever. We then use a 1993 nationally representative survey to investigate the redistributive consequences of the transfers, documenting who receive the pensions, their levels of living, and those of their families. We also look at behavioural effects, particularly the effects of the cash receipts on the allocation of income to food, schooling, transfers, and savings. The pressing policy issue for South Africans is whether it makes sense to target seven billion rand (nearly $2 billion) of social expenditure through the current pension schemes. Our analysis contributes to the discussion by documenting the redistributive and behavioural effects of the transfers. We find that, at least as far as immediate incidence is concerned, and without allowance for behavioural effects, the social pension is an effective tool of redistribution, and that the households it reaches are predominantly poor. Because so many of the elderly among South Africa's African population live with children, the social pension is also effective in putting money into house

Abstract: Several developing economies have recently introduced conditional cash transfer programs, which provide money to poor families contingent on certain behavior, usually investments in human capital, such as sending children to school or bringing them to health centers. The approach is both an alternative to more traditional social assistance programs and a demand-side complement to the supply of health and education services. Unlike most development initiatives, conditional cash transfer programs have been subject to rigorous evaluations of their effectiveness using experimental or quasi-experimental methods. Evaluation results for programs launched in Colombia, Honduras, Jamaica, Mexico, Nicaragua, and Turkey reveal successes in addressing many of the failures in delivering social assistance, such as weak poverty targeting, disincentive effects, and limited welfare impacts. There is clear evidence of success from the first generation of programs in Colombia, Mexico, and Nicaragua in increasing enrollment rates, improving preventive health care, and raising household consumption. Many questions remain unanswered, however, including the potential of conditional cash transfer programs to function well under different conditions, to address a broader range of challenges among poor and vulnerable populations, and to prevent the intergenerational transmission of poverty.

Abstract: ContextCash transfers conditional on certain behaviors, intended to provide access to social services, have been introduced in several developing countries The effectiveness of these strategies in different contexts has not previously been the subject of a systematic reviewObjectiveTo assess the effectiveness of conditional monetary transfers in improving access to and use of health services, as well as improving health outcomes, in low- and middle-income countriesData SourcesRelevant publications were identified via electronic medical and social science databases from inception to April 2006 (PubMED, EMBASE, POPLINE, CAB Direct, Healthcare Management Information Consortium, WHOLIS (World Health Organization Library Database), African Healthline, International Bibliography of the Social Sciences (IBSS), Eldis, British Library for Development Studies (BLDS), ID21, Journal Storage (Jstor), Inter-Science, ScienceDirect, Internet Documents in Economics Access Service (Research Papers in Economics) (IDEAS[Repec]), Latin American and Caribbean Health Sciences Literature (LILACS), MEDCARIB, Virtual Library in Health (ADOLEC), Pan American Health Organization (PAHO), FRANCIS, The Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effectiveness, and the Effective Practice and Organization of Care Group (EPOC) Register Reference lists of relevant papers and “gray” literature resources were also searchedStudy SelectionTo be included, a paper had to meet study design criteria (randomized controlled trial, interrupted time series analysis, and controlled before and after study) and include a measure of at least 1 of the following outcomes: health care utilization, health expenditure, or health outcomes Twenty-eight papers were retrieved for assessment and 10 were included in this reviewData ExtractionMethodological details and outcomes were extracted by 2 reviewers who independently assessed the quality of the papersResultsOverall, the evidence suggests that conditional cash transfer programs are effective in increasing the use of preventive services and sometimes improving health statusConclusionsFurther research is needed to clarify the cost effectiveness of conditional cash transfer programs and better understand which components play a critical role The potential success and desirability of such programs in low-income settings, with more limited health system capacity, also deserves more investigation