The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia

Abstract

Objective: Conditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment.

Design: Secondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas.

Setting: Colombia.

Subjects: Children (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities.

Results: Familias en Accion was associated with a significant increase in the probability of using preventive care services (OR=1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (β=1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas.

Conclusion: CCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.

Keywords: Conditional cash transfer programmes; Health; Income; Intervention; Nutrition; Poverty.

Fig. 1

Diagram to identify determinants that might affect child health and nutrition through the FA programme. This diagram shows the impact of the CCT programme on multiple outcomes ranging from the conditionalities required to receive the transfers (shaded in grey) to more distal determinants (continuous line). It also includes potential confounders at the individual, household and municipality level (dashed borderline). (FA, Familias en Accion; CCT, conditional cash transfer)

Fig. 2

Trends in the conditionalities for control and treatment municipalities, Familias en Accion, Colombia, 2002–2006. Trends in (a) health-care services use, (b) frequency of growth and development check-ups, (c) registration in growth and development programme, (d) attendance at diarrhoea workshop, (e) attendance at nutrition workshop, (f) attendance at acute respiratory infection workshop and (g) attendance at prenatal care workshop. , 2002 (baseline); , 2003 (first follow-up); , 2005–06 (second follow-up). Values are percentages with their 95 % confidence interval represented by vertical bars, or means with their standard deviation represented by vertical bars (b)

Fig. 3

Trends in child food consumption, Familias en Accion, Colombia, 2002–2006. Trends in (a) dairy products, (b) meat, (c) fish, (d) eggs, (e) legumes, (f) vegetables and (g) fruits. , 2002 (baseline); , 2003 (first follow-up); , 2005–06 (second follow-up). Values are percentages with their 95 % confidence interval represented by vertical bars

Fig. 4

Trends in child dietary diversity, Familias en Accion, Colombia, 2002–2006. Trends in dietary diversity score (range 0–56) categorized in tertiles as (a) low (score=0–15), (b) average (score=16–21) and (c) high (score=22–56). , 2002 (baseline); , 2003 (first follow-up); , 2005–06 (second follow-up). Values are percentages with their 95 % confidence interval represented by vertical bars

Fig. 5

Trends in women’s empowerment, maternal employment, knowledge, attitudes and practices, Familias en Accion, Colombia, 2002–2006. Trends in (a) mother’s empowerment on food, (b) mother’s empowerment on childcare, (c) maternal employment, (d) mother’s working hours, (e) mother’s knowledge, attitudes and practices on diarrhoea and fluids replacement and (f) mother’s knowledge, attitudes and practices on diarrhoea and food intake. , 2002 (baseline); , 2003 (first follow-up); , 2005–06 (second follow-up). Values are percentages with their 95 % confidence interval represented by vertical bars, or means with their standard deviation represented by vertical bars (d)