Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades

Abstract

Background: Many governments have implemented conditional cash transfer (CCT) programmes with the goal of improving options for poor families through interventions in health, nutrition, and education. Families enrolled in CCT programmes receive cash in exchange for complying with certain conditions: preventive health requirements and nutrition supplementation, education, and monitoring designed to improve health outcomes and promote positive behaviour change. Our aim was to disaggregate the effects of cash transfer from those of other programme components.

Methods: In an intervention that began in 1998 in Mexico, low-income communities (n=506) were randomly assigned to be enrolled in a CCT programme (Oportunidades, formerly Progresa) immediately or 18 months later. In 2003, children (n=2449) aged 24-68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes. We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates, including measures of household socioeconomic status.

Findings: A doubling of cash transfers was associated with higher height-for-age Z score (beta 0.20, 95% CI 0.09-0.30; p<0.0001), lower prevalence of stunting (-0.10, -0.16 to -0.05; p<0.0001), lower body-mass index for age percentile (-2.85, -5.54 to -0.15; p=0.04), and lower prevalence of being overweight (-0.08, -0.13 to -0.03; p=0.001). A doubling of cash transfers was also associated with children doing better on a scale of motor development, three scales of cognitive development, and with receptive language.

Interpretation: Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health, growth, and development.

Conflict of interest statement

Conflict of interest statement:

None of the authors had a conflict of interest.

Figures

Figure 1

Study Design *Communities only included in 2003 survey if included at least 10 children under 5 years old.

Figure 2

Scenario specifying projected Oportunidades cumulative cash transfers for simulated large and small families.* * Small family is defined as having only one child who turned 6 years old in 1997, and large family as one in which there are three children, including two boys aged 10 and 12 and one girl aged 8 (as of 1997). The “Early Intervention” group began receiving cash transfers in April of 1998 (Wave 2), and the “Late Intervention” group began receiving transfers in October 1999 (Wave 5). The survey described in this paper took place after Wave 12.