By increasing the cash transfer component of Mexico’s Oportunidades program, better outcomes in child health, growth, and development were made, according to an Article published in the March 8, 2008 issue of The Lancet.
Globally, over 200 million children younger than five years are not fulfilling their potential for growth, brain function, or socioemotional development. This development process may be blocked by many factors, including poor sanitation, a large family size, deficit in psychosocial stimulation, and a general lack of resources. As a result, when they grow up, children in the developing world who are growing up in poverty are likely to have substantially lower wages as adults, thus perpetuating their impoverished state on to their children.
The method by which intervention should be taken to improve child health and wellbeing is extremely important. Several governments in developing countries, especially in Latin America, have begun trials of conditional cash transfer (CCT) programs to address the issues related to poverty. To qualify, families must have an income below a determined level or live in a certain geographical area, and to receive payment they must comply with certain requirements. For instance: most CCT programs give payment conditional on mandatory attendance at education sessions related to preventive-health care services and health and nutrition. Others require school attendance for school aged children.
To investigate the success of these programs, Dr Lia Fernald, School of Public Health, University of California, Berkeley, CA, USA, and colleagues examined Mexico’s Oportunidades program, which was previously called Progresa, and which has been in effect since 1998. A total 506 low-income communities were randomly assigned to be enrolled in Oportunidades, either effective immediately or within 18 months. A total 2449 children between the ages of 24 and 68 months, who had been enrolled in the program since birth, were assessed for several outcomes.
It was found that by doubling the cash transfers in a household, improvements were made in all areas in the children. They found:
- An approximate 1cm increase in height
- 10% fewer stunted children
- Reduced age-adjusted body mass equivalent of just under one half pound
- 8% reduction in overweight children
The authors conclude with hopeful news for this sort of program, especially when performed with other program components. “Our results suggest that the household cash transfer component of a large-scale CCT programme is associated with critically important child health, growth, and development outcomes, including height for age, stunting, being overweight, several measures of cognitive development, and language development. Our findings support the notion that Oportunidades is achieving its objectives in these domains via cash transfer.” They pointedly state that this cash transfer likely works in tandem with other Oportunidades programs, including health care, nutrition supplementation, and nutrition education.
Dr Kenji Shibuya, WHO, Geneva, Switzerland, contributed an accompanying Comment, in which he suggests future actions involving CCT: “CCT could be combined with ongoing efforts to enhance the provision of health services to poor people in many low-resource settings — through performance-based funding and health-systems strengthening — and simultaneously introduce behavioural changes and incentives.”
Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico’s Oportunidades
Dr Lia CH Fernald PhD, Paul J Gertler PhD and Lynnette M Neufeld PhD
The Lancet 2008; 371:828-837
DOI:10.1016/S0140-6736(08)60382-7
Written by Anna Sophia McKenney