Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2009 Oct 7;2009(4):CD008137.
doi: 10.1002/14651858.CD008137.

The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries

Mylene Lagarde  1 , Andy Haines, Natasha Palmer
Affiliations
Meta-Analysis

The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries

Mylene Lagarde et al. Cochrane Database Syst Rev. .

Abstract

Background: Conditional cash transfers (CCT) provide monetary transfers to households on the condition that they comply with some pre-defined requirements. CCT programmes have been justified on the grounds that demand-side subsidies are necessary to address inequities in access to health and social services for poor people. In the past decade they have become increasingly popular, particularly in middle income countries in Latin America.

Objectives: To assess the effectiveness of CCT in improving access to care and health outcomes, in particular for poorer populations in low and middle income countries.

Search strategy: We searched a wide range of international databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, in addition to development studies and economic databases. We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature. The original searches were conducted between November 2005 and April 2006. An updated search in MEDLINE was carried out in May 2009.

Selection criteria: CCT were defined as monetary transfers made to households on the condition that they comply with some pre-determined requirements in relation to health care. Studies had to include an objective measure of at least one of the following outcomes: health care utilisation, health expenditure, health outcomes or equity outcomes. Eligible study designs were: randomised controlled trial, interrupted time series analysis, or controlled before-after study of the impact of health financing policies following criteria used by the Cochrane Effective Practice and Organisation of Care Group.

Data collection and analysis: We performed qualitative analysis of the evidence.

Main results: We included ten papers reporting results from six intervention studies. Overall, design quality and analysis limited the risks of bias. Several CCT programmes provided strong evidence of a positive impact on the use of health services, nutritional status and health outcomes, respectively assessed by anthropometric measurements and self-reported episodes of illness. It is hard to attribute these positive effects to the cash incentives specifically because other components may also contribute. Several studies provide evidence of positive impacts on the uptake of preventive services by children and pregnant women. We found no evidence about effects on health care expenditure.

Authors' conclusions: Conditional cash transfer programmes have been the subject of some well-designed evaluations, which strongly suggest that they could be an effective approach to improving access to preventive services. Their replicability under different conditions - particularly in more deprived settings - is still unclear because they depend on effective primary health care and mechanisms to disburse payments. Further rigorous evaluative research is needed, particularly where CCTs are being introduced in low income countries, for example in Sub-Saharan Africa or South Asia.

PubMed Disclaimer

Conflict of interest statement

None known.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Attanasio 2005 {published data only}
    1. Attanasio O, Gómez LC, Heredia P, Vera‐Hernandez M. The short‐term impact of a conditional cash subsidy on child health and nutrition in Colombia. The Institute of Fiscal Studies, London. London, 2005.
Barham 2005a {published data only}
    1. Barham T. The Impact of the Mexican Conditional Cash Transfer on Immunization Rates. Department of Agriculture and Resource Economics, U.C. Berkeley 2005.
Behrman 2005 {published data only}
    1. Behrman JR, Hoddinott J. Programme Evaluation with Unobserved Heterogeneity and Selective Implementation: The Mexican PROGRESA Impact on Child Nutrition. Oxford Bulletin of Economics and Statistics 2005;67:547‐69.
Gertler 2000 {published data only}
    1. Gertler P. Final report: the Impact of PROGESA on Health. International Food Policy Research Institute 2000.
Gertler 2004a {published data only}
    1. Gertler P. Do conditional cash transfers improve child health? Evidence from PROGRESA's control randomized experiment?. American Economic Review 2004;94:336‐41. - PubMed
Maluccio 2004 {published data only}
    1. Maluccio J, Flores R. Impact evaluation of a conditional cash transfer program: the Nicaraguan Red de Proteccion Social. FCND Discussion paper No 184. Washington, DC, IFPRI 2004.
Morris 2004a {published data only}
    1. Morris SS, Flores R, Olinto P, Medina JM. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: Cluster randomised trial. Lancet 2004;364:2030‐7. - PubMed
Morris 2004b {published data only}
    1. Morris SS, Olinto P, Flores R, Nilson EAF, Figueiró AC. Conditional Cash Transfers Are Associated with a Small Reduction in the Rate of Weight Gain of Preschool Children in Northeast Brazil. Journal of Nutrition 2004;134:2336‐41. - PubMed
Rivera 2004 {published data only}
    1. Rivera JA, Sotres‐Alvarez D, Habicht JP, Shamah T, Villalpando S. Impact of the Mexican Programmefor Education, Health, and Nutrition (Progresa) on Rates of Growth and Anemia in Infants and Young Children: A Randomized Effectiveness Study. JAMA 2004;291:2563‐70. - PubMed
Thornton 2006 {published data only}
    1. Thornton R. The demand for and impact of learning HIV status: Evidence from a field experiment. Harvard University 2006.

References to studies excluded from this review

Ahmed 2003 {published data only}
    1. Ahmed SM. Healthcare for the ultra‐poor: the case of BRAC's CFPR/TUP programme. Department for International Development Health Systems Resource Centre 2003.
Attanasio 2005b {published data only}
    1. Attanasio O, Battistin E, Fitzsimons E, Vera‐Hernandez M. How effective are conditional cash transfers? Evidence from Colombia. Institute for Fiscal Studies Briefing Notes 2005.
Barham 2005b {published data only}
    1. Barham T. Providing a healthier start of life: the impact of Conditional Cash transfers on infant mortality. Department of Agriculture and Resource Economics, U.C. Berkeley 2005.
Behrman 2001 {published data only}
    1. Behrman JR, Hoddinott J. An evaluation of the impact of Progresa on pre‐school child height. International Food Policy Research Institute, Food Consumption and Nutrition Division, Washington, D.C. 2001.
Behrman 2004 {published data only}
    1. Behrman JR, Parker SW, Todd PE. Medium‐Term Effects of the Oportunidades Programme Package, including Nutrition, on Education of Rural Children Age 0‐8 in 1997. Technical Document Number 9 on the Evaluation of Oportunidades 2004.
Borghi 2005 {published data only}
    1. Borghi J, Gorter A, Sandiford P, Segura Z. The cost‐effectiveness of a competitive voucher scheme to reduce sexually transmitted infections in high‐risk groups in Nicaragua. Health Policy and Planning 2005;20:222‐31. - PubMed
Chase 2001 {published data only}
    1. Chase R, Benz‐Sherburne L. Household effects of community Education and health initiatives: evaluating the impact of the Zambia Social Fund. Africa Impact Evaluation Initiative 2001.
Coady 2001 {published data only}
    1. Coady D. An evaluation of the distributional power of PROGRESA's cash transfer in Mexico. International Food Policy Research Institute 2001.
Dupas 2005 {published data only}
    1. Dupas P. The Impact of Conditional In‐Kind Subsidies on Preventive Health Behaviors: Evidence from Western Kenya. working paper. EHESS‐PSE, Paris 2005.
Gertler 2001 {published data only}
    1. Gertler P, Boyce S. An Experiment in Incentive‐Based Welfare: The Impact of PROGESA on Health in Mexico. University of California, Berkeley 2001.
Gertler 2004b {published data only}
    1. Gertler P, Fernald L. The Medium Term Impact of OPORTUNIDADES on Child Development in Rural Areas. Cuernavaca, Mexico: Instituto Nacional de Salud Publica 2004.
Levy 2003 {published data only}
    1. Levy D, Ohls J. Evaluation of Jamaica's PATH Program: Methodology Report. Mathematica Policy Research, Washington, D.C. 2003.
Mushi 2003 {published data only}
    1. Mushi AK, Schellenberg JRMA, Mponda H, Lengeler C. Targeted subsidy for malaria control with treated nets using a discount voucher system in Tanzania. Health Policy and Planning 2003;18:163‐71. - PubMed
Pritchett 2002 {published data only}
    1. Pritchett L, Sumarto S, Suryahadia A. Targeted Programmes in an Economic Crisis: Empirical Findings from Indonesia's Experience. CID Working Paper No. 95, Harvard University 2002.
Saadah 2001 {published data only}
    1. Saadah F, Pradhan M, Sparrow R. The Effectiveness of the Health Card as an Instrument to Ensure Access to Medical Care for the Poor During the Crisis. report for World Bank, 2001.
Sandiford 2005 {published data only}
    1. Sandiford P, Salvetto M, Segura Z, Gorter A. A voucher scheme to give female sex workers access to high quality health services provided by private micro‐enterprises. working paper. 2005.
Savedoff 2000 {published data only}
    1. Savedoff W. Reaching the poor through demand Subsidies: the Colombian health reform. Inter‐American Development Bank 2000.
Schubert 2005 {published data only}
    1. Schubert 2005. The Pilot Social Cash Transfer Scheme Kalomo District ‐ Zambia. Chronic Poverty Research Centre (Working Paper 52) 2005.
Weeden 1986 {published data only}
    1. Weeden D, Bennett A, Lauro D, Viravaidya M, Techo W. Community‐based incentives: increasing contraceptive prevalence and economic opportunity. Asia‐Pacific Population Journal 1986;1:31‐46. - PubMed

References to studies awaiting assessment

Fernald 2008a {published data only}
    1. Fernald LC, Gertler PJ, Neufeld LM. Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades. Lancet 2008;371:828‐37. - PMC - PubMed
Fernald 2008b {published data only}
    1. Fernald LC, Hou X, Gertler PJ. Oportunidades program participation and body mass index, blood pressure, and self‐reported health in Mexican adults. Preventing Chronic Disease 2008;5:2‐12. - PMC - PubMed
Fernald 2008c {published data only}
    1. Fernald LC, Gertler PJ, Hou X. Cash Component of Conditional Cash Transfer Program Is Associated with Higher Body Mass Index and Blood Pressure in Adults. Journal of Nutrition 2008;138:2250‐7. - PMC - PubMed
Jones 2008 {published data only}
    1. Jones N, Vargas R, Villar E. Cash transfers to tackle childhood poverty and vulnerability: an analysis of Peru's Juntos programme. Environment and Urbanization 2008;20:255‐73.
Levy 2007 {published data only}
    1. Levy D, Ohls J. Evaluation of Jamaica's PATH Program: Final Report. Mathematica Policy Research, Washington D.C. 2007.
Powell‐Jackson 2008 {published data only}
    1. Powell‐Jackson T, Neupane BD, Tiwari S, Morrison J, Costello A. Evaluation of the Safe Delivery Incentive Programme: Final report of the evaluation. Support to Safe Motherhood Programme, Nepal 2008.

Additional references

Behrman 1999
    1. Behrman JR, Todd P. Randomness in the experimental samples of PROGRESA (Education, Health and Nutrition Program). International Food Policy Research Institute, Washington, DC.
Courty 2004
    1. Courty P, Marschke G. An empirical investigation of gaming responses to explicit performance incentives. Journal of Labor Economics 2004;22:23‐56.
Ensor 2003
    1. Ensor T. Consumer‐led demand side financing for health and education : an international review. Oxford Policy Management 2003. - PubMed
EPOC 2002
    1. Data Collection Checklist. Cochrane Effective Practice and Organisation of Care Review Group. http://www.epoc.cochrane.org/Files/Website%20files/Documents/Reviewer%20... (accessed 4 May 2009).
Lagarde 2006
    1. Lagarde M, Palmer N. The impact of health financing strategies on access to health services in low and middle income countries. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD006092] - DOI - PMC - PubMed
Lagarde 2007
    1. Lagarde M, Haines A, Palmer N. Conditional Cash Transfers for Improving Uptake of Health Interventions in Low‐ and Middle‐Income Countries ‐ A Systematic Review. JAMA 2007;298:1900‐10. - PubMed
Ministry of Health and Family Welfare 2005
    1. Ministry of Health and Family Welfare. Janani Suraksha Yojana: Guidelines for implementation. Government of India, New Dehli 2005.
Nepal 2005
    1. Nepal GO. Maternity incentive scheme guidelines. Family Health Division, GoN, Kathmandu 2005.
Powell‐Jackson 2009
    1. Powell‐Jackson T, Morrison J, Tiwari S, Neupane BD, Costello AM. The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal. BMC Health Services Research 2009;9:97. - PMC - PubMed
Propper 2003
    1. Propper C, Wilson D. The Use and Usefulness of Performance Measures in the Public Sector. Oxford Review of Economic Policy 2003;19:250‐67.
Rawlings 2005
    1. Rawlings LB, Rubio GM. Evaluating the Impact of Conditional Cash Transfer Programmes: Lessons from Latin America. World Bank Research Observer 2005;20:29‐55.
Ukoumunne 1999
    1. Ukoumunne O, Gulliford M, Chinn S, Sterne JA, Burney PG. Methods for evaluating area‐wide and organization‐based interventions in health and health care: a systematic review. Health Technology Assessment 1999;3:iii‐92. - PubMed
World Bank 2006
    1. Data & Statistics, World Bank. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20....

References to other published versions of this review

Lagarde 2007a
    1. Lagarde M, Haines A, Palmer N. Conditional Cash Transfers for Improving Uptake of Health Interventions in Low‐ and Middle‐Income Countries ‐ A Systematic Review. JAMA 2007;298:1900‐10. - PubMed

MeSH terms

LinkOut - more resources