title: Eradicating diseases: The effect of conditional cash transfers on vaccination coverage in rural Nicaragua. Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme. Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial 10-year effect of Oportunidades, Mexico's conditional cash transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up study Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: a randomized effectiveness trial. Does money matter? The effects of cash transfers on child development in rural Ecuador. Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA’s Control Randomized Experiment.
abstract: Despite significant global efforts to improve vaccination coverage against major childhood diseases , vaccination rates are below 90 % . To eradicate diseases such as measles , however , vaccination rates close to 95 % are needed . We use a r and omized experiment to investigate the effect of a dem and incentive , a conditional cash transfer program , in improving  vaccination coverage in rural Nicaragua . Double-difference estimates show the program led to large increases in vaccination coverage , and these result ed in vaccination levels greater than 95 % for some vaccines . Effects were especially large for children who are typically harder to reach with traditional supply-side interventions OBJECTIVES To evaluate the impact of Mexico 's conditional cash transfer programme on the quality of health care received by poor women . Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines . METHODS The data describe retrospective reports of care received from 892 women in poor rural communities in seven Mexican states . The women were participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 . Eligible women accepted cash transfers conditional on obtaining health care and nutritional supplements , and participated in health education sessions . RESULTS Oportunidades beneficiaries received 12.2 % more prenatal procedures compared with non-beneficiaries ( adjusted mean 78.9 , 95 % Confidence Interval ( CI ) : 77.5 - 80.3 ; P < 0.001 ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with better quality of prenatal care for low-income , rural women in Mexico . This result is probably a manifestation of the programme 's empowerment goal , by encouraging beneficiaries to be informed and active health consumers BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children BACKGROUND  Mexico 's conditional cash transfer programme , Oportunidades , was started to improve the lives of poor families through interventions in health , nutrition , and education . We investigated the effect of Oportunidades  on children almost 10 years after the programme began . METHODS From April , 1998 , to October , 1999 , low-income communities were r and omly assigned to be enrolled in Oportunidades immediately ( early treatment , n=320 ) or 18 months later ( late treatment , n=186 ) . In 2007 , when 1093 children receiving early treatment and 700 late treatment in these communities were aged 8 - 10 years , they were assessed for outcomes including physical growth , cognitive and language development , and socioemotional development . The primary objective was to investigate outcomes associated with an additional 18 months in the programme . We used cluster-adjusted t tests and multivariate regressions to compare effects of programme participation for height-for-age , body-mass index ( BMI ) , and cognitive language and behavioural assessment scores in early versus late treatment groups . FINDINGS Early enrolment reduced behavioural problems for all children in the early versus late treatment group ( mean behaviour problem score -0.09 [ SD 0.97 ] vs 0.13 [ 1.03 ] ; p=0.0024 ) , but we identified no difference between groups for mean height-for-age Z scores ( -1.12 [ 0.96 ] vs -1.14 [ 0.97 ] ; p=0.88 ) , BMI -for-age Z scores ( 0.14 [ 0.99 ] vs 0.17 [ 1.06 ] ; p=0.58 ) , or assessment scores for language ( 98.8 [ 13.8 ] vs 98.4 [ 14.6 ] p=0.90 ) or cognition ( 98.8 [ 12.9 ] vs 100.2 [ 13.2 ] ; p=0.26 ) . An additional 18 months of the programme before age 3 years for children aged 8 - 10 years whose mothers had no education result ed in improved child growth of about 1.5 cm assessed as height-for-age [ corrected ] Z score ( beta 0.23 [ 0.023 - 0.44 ] p=0.029 ) , independently of cash received . INTERPRETATION An additional 18 months in the Oportunidades programme has independent beneficial effects other than money , especially for women with no formal education . The money itself also has significant effects on most outcomes , adding to existing evidence for interventions in early childhood . FUNDING Mexican Ministry of Social Development and the National Institutes of Child Health and Human Development BACKGROUND Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries by lack of dem and . In Latin America , some governments have been trying to increase dem and for health interventions by making direct payments to poor households contingent on them keeping up-to- date with preventive health services . We undertook a public health programme effectiveness trial in Honduras to assess this approach , contrasting it with a direct transfer of re sources to local health teams . METHODS 70 municipalities were selected because they had the country 's highest prevalence of malnutrition . They were allocated at r and om to four groups : money to households ; re sources to local health teams combined with a community-based nutrition intervention ; both packages ; and neither . Evaluation surveys of about 5600 households were undertaken at baseline and roughly 2 years later . Pregnant women and mothers of children younger than 3 years old were asked about use of health services ( primary outcome ) and coverage of interventions such as immunisation and growth monitoring  ( secondary outcome ) . Reports were supplemented with data from children 's health cards and government service utilisation data . Analysis was by mixed effects regression , accounting for the municipality-level r and omisation . FINDINGS The household-level intervention had a large impact ( 15 - 20 percentage points ; p<0.01 ) on the reported coverage of antenatal care and well-child check-ups . Childhood immunisation series could thus be started more opportunely , and the coverage of growth monitoring was markedly increased ( 15 - 21 percentage points ; p<0.01 . Measles and tetanus toxoid immunisation were not affected . The transfer of re sources to local health teams could not be implemented properly because of legal complications . INTERPRETATION Conditional payments to households increase the use and coverage of preventive health care interventions We examined the effects of Ecuador 's  Bono de Desarrollo Humano (BDH)--an unconditional cash transfer program that was rolled-out using a r and omized design --on health and development outcomes in very young children . Communities that were r and omly assigned to the treatment group began receiving the BDH  in 2004 and those r and omly assigned to the comparison group began receiving benefits two years later . Families enrolled in the BDH  received a monthly cash stipend ( $ 15USD ) representing an approximate 6 - 10 % increase in household income . Participants analyzed in this study are children aged 12 - 35 months from treatment ( n = 797 ) and comparison ( n = 399 ) communities in rural and urban Ecuador . Main outcomes measured were language skills ( the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas-Breve ) , height-for-age z-score , and hemoglobin concentration . Results indicate that in rural areas , being r and omized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying , and on the probability that the child was combining two or more words . There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas . A limited number of potential pathways with respect to cognitive/ language stimulation , health behaviors , and parenting quality were also explored . Findings indicate that compared to children in comparison areas , rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months . This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas A large body of research indicates that child development is sensitive to early-life environments , so that poor children are at higher risk for poor cognitive and behavioral outcomes . These developmental outcomes are important determinants of success in adulthood . Yet , remarkably little is known about whether poverty-alleviation programs improve children 's developmental outcomes . We examine how a  government-run cash transfer program for poor mothers in rural Ecuador influenced the development of young children .  R and om assignment at the parish level is used to identify program effects . Our data include a set of measures of cognitive ability that are not typically included in experimental or quasi-experimental studies of the impact of cash transfers on child well-being , as well as a set of physical health measures that may be related to developmental outcomes . The cash transfer program had positive , although modest , effects on the physical , cognitive , and socioemotional development of the poorest children in our sample Do Conditional Cash Transfers  Improve Child Health ? Evidence from PROGRESA 's Control R and omized Experiment Author(s ) : Paul Gertler Source : The American Economic Review , Vol . 94 , No. 2 , Papers and Proceedings of the One Hundred Sixteenth Annual Meeting of the American Economic Association San Diego , CA , January 3 - 5 , 2004 ( May , 2004 ) , pp . 336 - 341 Published by : American Economic Association Stable URL : http://www.jstor.org/stable/3592906 . Accessed : 13/03/2014
target: The quality of evidence on the effect of financial incentives on breastfeeding practice s was low but seems to indicate a potential positive impact on receiving colostrum , early initiation of breastfeeding , exclusive breastfeeding and mean duration of exclusive breastfeeding .
  There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization .
  Conclusions Financial incentives may have potential to promote increased coverage of several important child health interventions , but the quality of evidence available is low .
  The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services .
  Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits .
  This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers
background: Background Financial incentives are widely used strategies to alleviate poverty , foster development , and improve health .
  Cash transfer programs , microcredit , user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America , Sub-Saharan Africa , and more recently in Southeast Asia .
  Until now , no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted .
  The objective of this review is to provide estimates on the effect of six types of financial incentive programs : ( i ) Unconditional cash transfers ( CT ) , ( ii ) Conditional cash transfers ( CCT ) , ( iii ) Microcredit ( MC ) , ( iv ) Conditional Microcredit ( CMC ) , ( v ) Voucher schemes ( VS ) and ( vi ) User fee removal ( UFR ) on the uptake and coverage of health interventions targeting children under the age of five years .