Long-Term Follow-Up Of Children Enrolled In Mexico's Conditional Cash Transfer (CCT) Program 'Oportunidades'

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Main Category: Public Health
Also Included In: Pediatrics / Children's Health
Article Date: 05 Nov 2009 - 0:00 PST

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An article published Online First and in a future edition of The Lancet reports that long-term follow-up of children enrolled in Mexico's conditional cash transfer (CCT) program 'Oportunidades' has shown a range of benefits for child health and development. Also, an additional eighteen months of inclusion in the Oportunidades program in very early childhood reduced the number of socio-emotional problems reported in children aged 8 to10 years. The article is the work of Professor Lia Fernald, School of Public Health, University of California, Berkeley, CA, USA, and colleagues.

One of the first CCT programs to be designed, Mexico's Oportunidades (previously Progresa) was started to improve the lives of poor families through interventions in health, nutrition, and education. The program improved child growth after two to five years of enrolment in rural and urban areas. Effects were strongest in vulnerable subgroups. The authors investigated in this study the effect of Oportunidades on children nearly ten years after the program began.

Low-income communities were randomly assigned to be enrolled in Oportunidades immediately (early treatment, n=320), from April 1997 to October 1998. Or they enrolled eighteen months later (late treatment, n=186). In 2007, 1,093 children in these communities aged 8 to 10 years were receiving early treatment. 700 children were receiving late treatment. They were assessed for outcomes including physical growth, cognitive and language development, and socio-emotional development. The primary objective was to investigate outcomes associated with the additional eighteen months in the program. The effects of program participation on height-for-age, body-mass index (BMI), and cognitive and language and behavioral assessment scores were compared in early versus late treatment groups.

Results indicated that early enrolment reduced behavioral problems for all children in the early versus late treatment group. However, there were no differences between groups for mean height-for-age, BMI-for-age, assessment scores for language, or cognition. An additional eighteen months of the program before age 3 years resulted in improved child growth for children aged 8 to10 years whose mothers had no formal education. It was of about 1.5 cm assessed as height-for-weight Z score, and independently of cash received.

Moreover, the authors explain: "Our results show a significant, independent, positive association between cumulative cash transfers and height, cognition, and vocabulary score, and a negative association with behavioural problems, agreeing with the results we reported for these children when they were aged 3-5 years."

They say in conclusion: "An inability to decipher the causal pathways by which CCTs have affected child outcomes is a key research gap. Our analysis takes advantage of the detailed information available for the Oportunidades programme in Mexico and the quality of cash transfer data to explore potential mechanisms for the effects of CCTs, recognising the limitations that this approach has for causal inferences. Together, these results suggest that independent beneficial effects of programme components exist in Oportunidades other than money-especially for women with no formal education-and that the money itself also has significant effects, adding to existing evidence for interventions in early childhood."

In an associated comment, Santiago Cueto, GRADE (Grupo de Anàlasis para el Desarrollo), Lima, Peru, remarks: "From the policy perspective, why the provision of services for poor people seems to be still low in many developing countries should be clarified. There are many reasons, such as the higher costs per person of reaching poor populations with high-quality services (because they often live in isolated areas) and the limited political power and voice of these groups (compared with wealthy populations). However, accumulated global evidence from research on several conditional cash transfer programmes suggests that they need to be a part of combined interventions to fight poverty rather than isolated programmes that could overcome inequality on their own."

"10-year effect of Oportunidades, Mexico's conditional cash transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up study"
Lia C H Fernald, Paul J Gertler, Lynnette M Neufeld
DOI: 10.1016/S0140-6736(09)61676-7
The Lancet

Written by Stephanie Brunner (B.A.)
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