Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition

Figures & data

Figure 1.  An asset-based social protection framework.

Table 1. Impacts of unconditional cash transfers on education.

Country/programme	Enrolment	Attendance
South Africa CSG	+8.1 percentage points** (age 6)^a
	+1.8 percentage points** (age 7)^a
	+25%^b§
South Africa OAP	+20–25%^b§
	+3%** (poorest boys)^c
	+7%*** (poorest girls)^c
Zambia SCTS^d§	+10.4 percentage points (ages 5–6)
	+3 percentage points (ages 7–18)
	+8 percentage points (ages 14–15)
	–2 percentage points (ages 16–18)
Malawi Mchinji Cash Transfer^e	+12 percentage points enrolment rate***	–1.3 days absent in previous month***
	+5 percentage points newly enrolled***
	–3 percentage points drop-out rate***
Sources: ^aCase, Hosegood, and Lund (2005), KwaZulu-Natal, Umkhanyakude District; ^bSamson et al. (2004), National, Income and Expenditure Survey (2000) and The Labour Force Survey (September 2000); ^cSamson et al. (2004), National, OHS data; ^dMCDSS/GTZ (2006), Kalomo District; ^eMiller, Tsoka, and Reichert (2008), Mchinji District.
*p<0.10, **p<0.05, ***p<0.01.
^§ p-Values not reported.

Figure 2.  Use of unconditional cash transfers, by type of spending and programme.

Sources: Acacia Consultants (2007); Devereux (2002); Devereux et al. (2007); Devereux, Mvula, & Solomon (2006); MCDSS/GTZ (2006); Moller and Ferreira (2003).

Note: In the case of Zambia SCTS the figure represents the proportion of overall spending by beneficiaries on health. In the case of Malawi DECT, these spending numbers refer to three months of the five-month programme period January–March 2007.

Table 2. Impacts of unconditional cash transfers on health.

Country/programme	Health outcomes
Malawi Mchinji Cash Transfer^a	Reduced illness in past month: –13 percentage points*** (children)
South Africa OAP^b	Improved health for all household members when income is pooled
Zambia SCTS^c§	Reduced incidence of illness:
	–12 percentage points (children 0–5 and adults 19–64)
	–14 percentage points (elderly)
Sources: ^aMiller, Tsoka, and Reichert (2008); ^bCase (2001); ^cMCDSS/GTZ (2006).
*p<0.10, **p<0.05, ***p<0.01.
^§ p-Values not reported.

Figure 3.  Impacts of conditional cash transfers on health service usage.

Sources: Attanasio et al. (2005); Gertler (2000); Gertler and Boyce (2001); IFPRI (2003); Maluccio and Flores (2005).

Note: The mean of the range of estimates is plotted for Honduras.

For Mexico the figure represents the impact on growth monitoring visits 15 months after baseline. No information on health visits separate from growth monitoring is available for Colombia.

Table 3. Impacts of unconditional cash transfer programmes on food consumption and nutrition.

Country/programme	Food consumption	Hunger/meals per day	Dietary diversity	Nutritional status
Malawi Mchinji Cash Transfer^a	83 percentage points difference in households reporting improved food intake***	+23 percentage points difference in households reporting being satisfied after meal*** –3.7 percentage points difference in households reporting very hungry**	+3.2 food groups consumed per day, on average***	–11 percentage points child underweight*No change in mean WAZ
Mozambique GAPVU^b	No impact	NA	NA	NA
South Africa CSG	+1.5 percentage points (all food items); +1.2 percentage points (basic food items)***^c			+0.2 HAZ, if received in first year of life and for at least 2/3 of first three years^*d
South Africa OAP	+1.5 percentage points (all foods)***^c+10.5 percentage points in real adult food expenditure (HIV-affected households)^§e	–25% chance that adult skipped meal (if pension income pooled)^f –5.8% probability of hunger (young child)^c		+2.23 cms (girls) +0.88 cms (boys) if pension received by woman (national)*^g+5 cms (Western Cape)^§f
Zambia SCTS^§h	NA	–6 percentage points households eating one meal/day +6 percentage points households eating three meals/day	+12 percentage points households consuming vitamins 7x/week +11.6 percentage points households consuming protein 7x/week +30.4 percentage points households consuming oil 1x/week	Possible reduction in percentage of underweight children
Sources: ^aMiller, Tsoka, and Reichert (2008); ^bLow, Garrett, and Ginja (1999); ^cSamson et al. (2004); ^dAgüero, Carter, and Woolard (2009); ^eBooysen (2004); ^fCase (2001); ^gDuflo (2003); ^hMCDSS/GTZ (2006).
*p<0.10, **p<0.05, ***p<0.01.
^§ p-Values not reported.
Note: The methods used in these studies are different and thus results should not be considered directly comparable.

Table 4. Unconditional cash transfer programme descriptions.

Country	Programme	Eligibility
Malawi	Mchinji Cash Transfer Programme	Ultra poor (lowest expenditure quintile, below national ultra poverty line – one meal/day, cannot purchase essential non-food items, no valuable assets) and labour constrained (dependency ratio >3, no household member 19–65 years able to work or >3 dependents per household member)
Mozambique	Gabinete de Apoio à População Vulnerável (GAPVU)	Absolute poor, household head unable to work and head is older woman 55+ or older man 60+, physically handicapped >18 or chronically sick >18, malnourished pregnant women, families with severely malnourished pregnant women or malnourished children
South Africa	Child Support Grant (CSG)	Children <14
South Africa	Old Age Pension (OAP)	Low-income men >65, women >60
Zambia	Social Cash Transfer Scheme (SCTS)	Destitute (extremely needy, difficulties surviving, e.g., insufficient food, shelter, clothing, no assets or support) and incapacitated (no fit household member (19–64 and not ill) or one with >3 dependents per household)
Sources: Low, Garrett, and Ginja (1999); MCDSS/GTZ (2007); Samson et al. (2004); Schubert and Huijbregts (2006).

Table 5. Conditional cash transfer programme descriptions.

Bangladesh	Reaching Out of School Children (ROSC)	Eligibility: Children who have not had an opportunity to attend primary school in remote areas/dropouts from primary Conditions: 75% attendance; 75% performance in exams
Brazil	Bolsa Alimentação	Eligibility: Poor families with pregnant/lactating women and children 0–6 years with monthly per capita income below specified threshold Conditions: Minimum schedule of pre-natal and post-natal care visits; child growth monitoring; up-to-date vaccinations; participation in nutrition education
	Bolsa Escola	Eligibility: Families with children 6–15 years and per capita monthly incomes no greater than R$90 (US$43) Conditions: 85% school attendance
Cambodia	Japan Fund for Poverty Reduction (JFPR) Girls Scholarship Programme	Eligibility: Girls starting Grade 7 Conditions: school enrolment; regular school attendance (no more than 10 days absence/year without “good reason”); maintaining a passing grade
Colombia	Familias en Acción	Eligibility: Extremely poor families with children 0–6 years not participating in other programmes (health) and/or children 7–17 years enrolled in school (education) Conditions: Growth monitoring and development check-ups (children 0–7)
Ecuador	Bono de Desarrollo	Eligibility: Households with children 0–16 years in the poorest two quintiles and poor households with elderly and/or disabled members Conditions: Bimonthly visits to health posts for growth and development check-ups and immunisations (children 0–5); School enrolment for children 6–15 years; school attendance of at least 90%
Honduras	Programa de Asignación Familiar (PRAF-II)	Eligibility: Poor households with pregnant women and/or children under three (health) with children 6–12 who have not yet completed the fourth grade of primary school (education) Conditions: Check-ups at health centre (children 0–5); Growth monitoring and promotion for mothers with children <2; At least five pre-natal check-ups; Attendance in at least four training courses/year (main beneficiary)
Jamaica	Programme of Advancement Through Health and Education (PATH)	Eligibility: Poor children ages 0–6 (health) and 6–17 (or until completion of secondary school); persons >60 years; pregnant or lactating women up to six months after delivery; poor, disabled and destitute adults <65; elderly >65 Conditions: Health visits (children and adults and pregnant and lactating women); school attendance of at least 85% (children 6–17)
Mexico	Programa de Educación, Salud y Alimentación (Progresa)/ Oportunidades	Eligibility: Poor households Conditions: School attendance (80% monthly and 93% annually); compliance by all household members with schedule of preventative health check-ups; attendance at health and nutrition lectures (family member older than 15)
Nicaragua	Red de Protección Social (RPS)	Eligibility: Poor households with children 0–5 (health); poor households with children 7–13 who have not yet completed fourth grade in primary school (education) Conditions: Attendance at health care visits (children 0–5); up-to-date vaccinations (children 0–5); monthly health education workshops
Turkey	Social Risk Mitigation Project (SRMP)	Eligibility: Poorest 6% of the population with children 0–6 years or in primary or secondary school (ages 6–17) and pregnant mothers Conditions: Clinic visits for health check-ups; give birth in hospital; school attendance of at least 80%; cannot repeat same grade twice
Sources: Ahmed et al. (2007); Levy and Ohls (2007); Maluccio and Flores (2005); World Bank (2009).

Figure 4.  Impacts of conditional cash transfers on stunting prevalence.*p<0.01

Table 6. Unconditional cash transfer programme evaluations reviewed.

Country	Programme	Study area	Study sample	Time period	Study design
Malawi	Mchinji Cash Transfer Scheme	Mchinji District	819 households (Round 1) 789 households (Round 2) 766 households (Round 3)	March 2007–March/April 2008	Longitudinal study with comparison group
Mozambique	GAPVU	Maputo	41 beneficiaries 40 non-beneficiaries (who meet eligibility criteria)	December 1997	Control group, only elderly beneficiaries
South Africa	Social grants	Free State Province	163 households	May 2001–December 2002	Cohort study of AIDS-affected households
South Africa	Social grants	National	30,000 households	2000	Model based on Income and Expenditure Survey, Labour Force Survey and Household Surveys
South Africa	Child Support Grant	KwaZulu-Natal Province	245 children receiving the CSG before age 3	1993, 1998 and 2004	Longitudinal KwaZulu-Natal Income Dynamics Study
South Africa	Child Support Grant	Umkhanyakude District, KwaZulu-Natal Province	11,178 households	2002–2004	Longitudinal demographic surveillance (Africa Centre for Health and Population Study), no strict control group
South Africa	Old Age Pension	Langeberg Health District, Western Cape	1300 individuals in 300 households	1999	Analysis of national survey data
South Africa	Old Age Pension	National	9000 households	August–December 1993	Analysis of health and economic survey
Zambia	SCTS	Two agricultural blocks in Kalomo District	Randomised sample of 303 households (274 at end line)	Kalomo: September 2004–September 2005 Kanchele: December 2004–December 2005	Pre–post, no control group
Sources: Acacia Consultants (2007); Agüero, Carter, and Woolard (2009); Bazo (1998); Booysen (2004); Case (2001); Case, Hosegood, and Lund (2005); Devereux, Mvula, and Solomon (2006); Devereux et al. (2006); Devereux, Mthinda, Power, Sakala, and Suka (2007); Duflo (2000, 2003); Gilligan, Hoddinott, and Taffesse (2007): MCDSS/GTZ (2006); Miller et al. (2007); Samson et al. (2004); Tarp et al. (2002).
^aKalomo central agricultural block: baseline, 146 households; end line, 128 households; Kanchele central agricultural block: baseline, 157 households; end line, 146 households.

Table 7. Conditional cash transfer evaluations and analyses reviewed.

Country	Programme	Study sample	Time period	Study design
Bangladesh	Reaching Out of School Children^a	1500 households	2006	Quasi-experimental design; DD, PSM
Brazil^b	Bolsa Alimentação ^b	2493 beneficiaries 506 excluded (but eligible) non-beneficiaries	April 2002 (and retrospective data: six months previous)	Ex-post quasi-randomised controlled trial
	Bolsa Escola ^c	2,387,677 children 10–15	2000	Household data from 2000 census, PSM
	Bolsa Escola ^d	293,800 eligible children	2004	Quasi-experimental, panel data from administrative records
Cambodia	Japan Fund for Poverty Reduction ^e	3623 girls	2003–2005	RDD, PSM: girls with completed applications (not random)
Colombia	Familias en Acción ^f	10,742 households (64,500 individuals)	2002–2003	Cluster matched study, PSM
Ecuador	Bono de Desarrollo Humano ^g	1306 households	2003–2005	Randomised longitudinal study
Honduras	PRAF II ^h	5683 households (26,866 individuals)	2000–2002	Randomised controlled trial
Jamaica	PATH ^I	5000 households	2004–2005	Longitudinal study with comparison group, RDD
Mexico	Progresa ^j	24,000 households	1998–1999	Randomised controlled trial
	Progresa ^k	4000 children	1998–1999	Randomised controlled trial
	Progresa ^l	Height: 155 children 12–36 months Anaemia: 2012 children 12–48 months	1998–2000	Randomised controlled trial
	Progresa ^m	650 children <12 months from low-income households (<50th income percentile)	1998–2000	Randomised controlled trial
Nicaragua	Red de Protección Social (RPS) ^n	1581 households (baseline) 1453 households (2001) 1397 households (2002)	2000–2002	Cluster randomised controlled trial
Turkey	Social Risk Mitigation Project ^o	2905 households	2005–2006	Cross-sectional study, RDD, PSM
Sources: ^aAhmed (2006); ^bMorris, Olinto, Flores, Nilson, and Figueiro (2004); ^cCardoso and Souza (2003); ^dde Janvry, Finan, and Sadoulet (2006); ^eFilmer and Schady (2006); ^fAttanasio and Gomez (2004); ^fAttanasio, Gomez, Heredia, and Vera-Hernandez (2005); ^gSchady and Araujo (2006); ^hIFPRI (2003); ^iLevy and Ohls (2007); ^jSkoufias (2005); ^kBehrman and Hoddinott (2001); ^lGertler (2004); ^mRivera, Sotres-Alvarez, Habicht, Shamah, and Villalpando (2004); ^nMaluccio and Flores (2005); ^oAhmed et al. (2006); ^oAhmed et al. (2007).
Note: PSM, propensity score matching; RDD, regression discontinuity design; DD, difference-in-differences.

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