CCT Programs Research Articles

‘dark side’ of the LEAP CCT programme in Ghana

Studies of social transfer targeting practices and mechanisms, including the proxy means test (PMT) instrument, have often assumed that the essential purpose of these mechanisms is to ensure fairness, cost-effectiveness and efficiency, yet there is limited consensus on their optimal performance. This article builds on recent studies of social transfer targeting practices in developing countries by providing a better interpretation of the power dynamics involved in ‘translating’ the PMT instrument at the intersection of official, public and cultural discourses. It is a Foucault-based study that combines ethnography and discourse studies to analyse the everyday actions and practices of programme officials and caregivers. This study demonstrates that officials legitimise and translate the PMT instrument, separate individuals from families, and constitute them as objects for governmental intervention to achieve efficiency and cost-effectiveness. The re-categorisation of family members into households ‘outside’ of everyday sociocultural relations and practices is contested and resisted, creating a complex system of power relationships around the PMT.

Not just money: what mothers value in conditional cash transfer programs in India

IntroductionConditional cash transfers (CCTs) have become an important policy tool for increasing demand for key maternal and child health services in low/middle-income countries. Yet, these programs have had variable success...

Incentives in Brazilian Bolsa Família CCT Program: Adverse selection, moral hazard, improving mechanisms and simulations

The Bolsa Família CCT Program (BFP) has successfully reduced poverty in Brazil. However, the theoretical literature on associated economic incentives is scarce. A mechanism-design analysis identifies problems of adverse selection and moral hazard in the BFP. The paper proposes simple improving incentive-mechanisms. The Citizens’ Contribution Mechanism (CCM) requires beneficiaries to devote time to the PBF encouraging recipients with higher income to leave. The Graduation Mechanism (GM) offers financial incentives to ensure sustainable emancipation of qualified beneficiaries. The Human Capital Incentive Mechanism (HCM) increases transfers to efficient municipalities. We show that the CCM solves the adverse selection problem, the GM solves the moral hazard problem of beneficiaries and the HCM solves a moral hazard problem of local managers. A simulation based on 2010 census data shows that the mechanisms allow, within 6 years, significant increases in the reach and precision of the PBF and yields cost reductions of over R$4.6 billion.

Targeting When Poverty is Multidimensional

The view of poverty as a multidimensional phenomenon has swiftly become mainstream. However, the debate remains open as to how such ‘multidimensional poverty’ should be assessed in practical settings, particularly when identifying the beneficiaries of poverty alleviation programmes. This paper develops a novel empirical approach that explicitly takes into account the goals and needs of thepolicy-maker. In particular, the paper takes up the case of a government official running a budget constrained programme to alleviate a few dimensions of poverty, and translates her concerns into a set of desiderata which the multidimensional measure should meet. The policy-maker targeting ability and aversion to the risk of leakages play crucial roles in setting the desired properties. We illustrate our methodology in the context of a CCT programme in Peru, and show that it improves expected leaking and undercoverage relative to alternative Alkire-Foster based approaches.

Cash Transfer Programs and Household Labor Supply

Employment contributes to reduce the risk of poverty. Through a randomized controlled trial, we evaluate the impact of a conditional cash transfer program (CCT) to low-income families with dependent children on household members’ labor supply. The attendance of labor-market-oriented mentoring courses constitutes the condition to obtain the transfer. One year after admission to the program, fathers assigned to the CCT program are more likely to work (+14 percent) than fathers assigned to an unconditional cash transfer program or to a pure control group. No effect arises for mothers. Increased paternal investments in activities enhancing labor market opportunities and improved family networks seem to explain the results.

Women’s Stated Preferences for Conditional Cash Transfer Programs Focused on Maternal and Child Health and Nutrition in India (P22-012-19)

ObjectivesConditional Cash Transfers (CCTs) are important national strategies to improve maternal and child health and nutrition. India recently began implementing a Maternity Benefit Program (MBP) to encourage health care use during pregnancy and early childhood; under discussion is to include child nutrition services within a CCT program. This paper aims to understand the preferences of mothers with young children for design features (cash transfer amount and conditionalities) of CCT programs. MethodsWe conducted a Discrete Choice Experiment in Uttar Pradesh, India where 405 mothers with children below three years of age were interviewed. Respondents were presented 18 hypothetical CCT program profiles defined by five attributes – cash transfer amount, number of ante-natal care visits, number of visits for child immunization/growth monitoring, time taken to complete a visit, and health benefit received (proxy for service quality). Conditional logit regression was used to analyze respondent choices. ResultsMothers valued the amount of cash transfer, quality of services, and quicker health center visits. They did not have a strong preference for the number of visits required. Higher cash amounts are associated with greater probability of participation. For any given amount of cash amount, better service quality (produced better health) elicited greater participation. Mothers put high valuation on service quality; they were willing-to-pay (give up) INR 2858 ($41) for a program that produced good health. Without any cash transfer, only improving service quality from average to good would increase participation by 27%. A cash transfer amount of INR 6000 ($86, currently offered by MBP) combined with fair (good) quality services would increase participation by 78% (85%). Preference for CCT programs differed across sub-groups defined by prior users of government health services and socioeconomic status. Poor households valued a given cash transfer amount more than better-off households, while better-off households valued good health outcomes more than poorer households. ConclusionsAligning maternal and child health CCT programs with user preferences can increase program participation. This study provides guidance on incorporating user preferences in the CCT program design. Funding SourcesDepartment of International Health, Johns Hopkins University.

Short-term computerized cognitive training does not improve cognition compared to an active control in non-demented adults aged 80 years and above.

Older adults, especially those above age 80, are the fastest growing segment of the population in the United States and at risk for age-related cognitive decline and dementia. There is growing evidence that cognitive activity and training may allow adults to maintain or improve cognitive functioning, but little is known about the potential benefit in the oldest old. In this randomized trial, the effectiveness of a computerized cognitive training program (CCT program) was compared to an active control games program to improve cognition in cognitively normal individuals aged 80 and older. Sixty-nine older adults were randomized to a 24-session CCT program (n = 39) or an active control program (n = 30). Participants completed a pre- and post- training neuropsychological assessment. The primary outcome measure was a global cognitive composite, and the secondary outcomes were the scores on specific cognitive domains (of memory, executive function/attention, and language). Using linear mixed models, there were no significant differences between the CCT and the active control program on the primary (p = 0.662) or any of the secondary outcomes (language functioning, p = .628; attention/executive functioning, p = .428; memory, p = .749). This study suggests that short-term CCT had no specific benefit for cognitive functioning in non-demented individuals aged 80 and older.

CCTs and conditionalities: an exploratory analysis of not meeting conditional cash transfer conditionalities in Chile's Families Programme

Since the mid-1990s, conditional cash transfer programmes have rapidly proliferated in Latin America, although little research has examined the characteristics of families who do not meet programme conditionalities. In order to contribute to this gap in knowledge, this study sought to identify the individual, family and programme variables associated with not meeting conditionalities of Chile's CCT. The study found that certain variables related to family vulnerability were associated with not meeting conditionalities. These findings uncover an important contradiction in Chile's CCT programme, since while seeking to guarantee social inclusion the programme may in fact be contributing to greater exclusion.

Households’ preferences for attributes of Conditional Cash Transfer programmes: A choice experiment in Ghana

AbstractConditional cash transfer (CCT) is increasingly being integrated into poverty reduction strategies in developing countries. However, debate remains over key elements of CCT programme design. Using a discrete choice model, this article examines Ghanaian households’ preferences regarding key CCT programme design elements including conditionality, targeting, and payment method. The results revealed a preference for CCT designs that target beneficiaries with limited or no productive capacity and CCT designs that are conditional on beneficiaries either investing in children's human capital or performing communal service, relative to unconditional programmes. Also, direct bank deposit was revealed as the preferred payment mode relative to receipt of cash payments or use of mobile money systems.

How could conditional cash transfer programme conditionalities reinforce vulnerability? Non‐compliers and policy implementation gaps in Uruguay's Family Allowances

AbstractInfluential research shows that conditionalities could incentivize recipients of conditional cash transfer programmes (CCTs) to send their children to school and to regular health check‐ups. However, a growing literature is elucidating the risks of conditional transfers, from both a philosophical and an empirical perspective. This article highlights the varied deficits that have accompanied the implementation process in some Latin American countries, as well as the consequences that these deficits might have on the beneficiaries. In particular, it suggests that, rather than reducing vulnerability by improving access to services, conditionalities could be reinforcing vulnerability among non‐compliers if non‐compliance leads to the immediate suspension of the cash transfer and if this sanction is poorly implemented.While this hypothesis has gained attention and is part of both an academic and a political debate, empirical research around it is scarce. This article is an attempt to start filling this gap by focusing on the implementation process of conditionalities in a CCT programme in Uruguay (Family Allowances) and how this is experienced by a group of recipients who failed to comply with the conditionalities and were sanctioned with the suspension of the benefit. In particular, it identifies the main reasons why these beneficiaries did not comply, how they experience the sanction and how they managed—when they do—to apply for the benefit to be restored.Based on a qualitative design of in‐depth interviews, it provides empirical evidence to unpack causal relationships linking conditionalities to increased vulnerability among non‐compliers. Our findings offer evidence on the role played by the conditionalities in reinforcing vulnerability and the possible causal mechanisms that could be operating between both phenomena. This picture of policy implementation constraints that could lead conditionalities to reinforce vulnerability among recipients could be relevant to policy‐makers having to deal with non‐compliance and managing sanctions in CCTs.

Circuit Class Training in water versus land in Post-Stroke patients: a protocol for a randomized controlled trial

INTRODUCTION: A high percentage of post-stroke patients have permanent aftermathsdespite conventional rehabilitation. Circuit class training offers an efficient way to achieve structured practice of task-related activities during stroke rehabilitation. Aquatic therapy is another therapeutic approach that offers a great variety of options to be a highly dynamic environment, which helps to improving functionality and recover quality of life and independence in people with disabilities. OBJECTIVE: To develop a protocol for a randomized controlled trial. METHODS: Forty participants will be randomized in two groups: aquatic circuit class training (ACCT) and land circuit class training (LCCT). In both groups, the intervention will be a 7-week class therapy, 3-times weekly, giving a total of 20 sessions, 60 minutes each. Blinded assessors will conduct assessments, using standardized tools: baseline, post-intervention, and 20 days follow-up for the effectiveness of the therapy in terms of gait, balance and upper limb motor function. RESULTS/CONCLUSION: This trial will examine the immediate and medium term effect of an ACCT program as compared to a LCCT program in people with stroke. It has the potential to identify interventions that may improve rehabilitation of these patients. Both CCT programs are based in International Classification of Function, Disability and Health model with activities aimed at impairment, activity and participation levels.

The continuous treatment effect of an antipoverty program on children's educational attainment: Colombia's Familias en Accion

AbstractEducational attainment is an important element in the formation of human capital. Although many developing countries have made strong efforts to expand the coverage of education services, children in poor households still struggle to attend school on a regular basis. Human development conditional cash transfers (known as CCTs) have emerged in response to this situation in developing countries. While the effects of the CCTs are well known and widely documented, their effects in relation to educational attainment and school participation are still unclear. This paper looks empirically into the continuous treatment effects of participation length in Familias en Accion, a CCT program in Colombia. The paper focuses on the continuous treatment effects on school registration and educational attainment of participants in the program. Although initial results show a fuzzy relationship between the program outcomes and the participation length, the empirical results confirm the fact that a longer exposure to the antipoverty program led to higher school registration rates, accumulation of years of education, and lower child labor participation levels.

Mechanical Structure for the PSI Canted-Cosine-Theta (CCT) Magnet Program

The Canted-Cosine-Theta (CCT) technology has the potential, by its intrinsic stress-management, to lower coil stresses in high-field accelerator magnets. This is especially relevant for Nb <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> Sn magnets, which may be subject to irreversible degradation if the coil stresses exceed critical values. The internal structure of CCT coils, however, dilutes the engineering current density. For an efficient design, the internal structure, therefore, needs to be reduced to the limit given by the computer-numerical-control machining capabilities. In that case, however, additional mechanical stiffness must be provided by an external mechanical structure. The mechanical structure for the Paul Scherrer Institut (PSI) CCT program, which is described in this paper, is based on the bladder and key concept. The CCT-specific deviations from the prevalent bladder and key implementations are discussed. In addition, a two-dimensional and three-dimensional analysis in all stages of loading, cooling, and powering of the first PSI magnet prototype, as well as a tolerance analysis, is reported.

Intra-household Behavioral Responses to Cash Transfer Programs. Evidence from a Regression Discontinuity Design

Summary Considering two-parent households with children, this study investigates the behavioral responses of men and women to a cash transfer program in Uruguay – Asignaciones Familiares-Plan de Equidad (AFAM-PE). We examine its effect on labor market responses, marital dissolution, and the decision-making process regarding the use of money. The assignment mechanism to the AFAM-PE exogenously alters the distribution of non-labor income across applicant households by targeting the monetary transfer (usually) to the female spouse. Our identification strategy exploits both the female targeting and a discontinuity in eligibility for enrollment into the program. Based on a regression discontinuity design and on a follow-up survey matched with program’s administrative records, this study finds that the program has significant negative effects on the formality choice of women at the eligibility cut-off. These responses seem to be associated with a lower rate of moving from unregistered jobs to formality. We also find suggestive evidence that the program results in women taking greater (perceived) responsibility for decisions in specific spheres of household expenditures. This study, represents one of the first efforts to analyze the distributional effects of CCT programs on different couples members’ behavioral responses. It offers relevant considerations for the ongoing debate about the impacts of these kind of programs on women’s agency in developing countries, suggesting the need to discuss new designs for social assistance that reduce discouraging effects on formality.

The effects of a household conditional cash transfer programme on coverage and quality of antenatal care: a secondary analysis of Indonesia’s pilot programme

ObjectiveTo analyse the effectiveness of a household conditional cash transfer programme (CCT) on antenatal care (ANC) coverage reported by women and ANC quality reported by midwives.DesignThe CCT was piloted as...

Compulsory education laws or incentives from CCT programs? Explaining the rise in secondary school attendance rate in Argentina

Argentina has traditionally stood out in terms of educational outcomes among its Latin American counterparts. Schooling of older children, however, still shows room for improvement especially among the more vulnerable. Fortunately, during the last years a sizeable improvement in attendance rates for children aged 15 through 17 took place. This could be related to the 2006 National Education Law that made upper-secondary education compulsory. In this paper, instead, we claim that the Asignación Universal por Hijo (Universal Child Allowance, AUH) -a massive conditional cash transfer program implemented in 2009 in Argentina- may be mostly responsible for this improvement. Using a difference-in-difference strategy we estimate that the program accounts for a 3.9 percentage point increase in the probability of attending secondary school among eligible children aged 15 through 17. The impact seems to be led by boys and is more relevant for children living in larger families where the head of household has a lower educational level.

Social Media Instruments and the Promotion of Financial Inclusion in Peruvian Rural Areas

This study seeks to evaluate the use of short soap operas as a mechanism to promote the use of formal savings accounts among poor rural women that have been secularly excluded from healthy interactions with the formal financial sector. We developed a short soap opera (telenovela), named Josefa, which transmitted pro-savings messages using characters and stories that could generate a level of identification with the intended audience. We used an experimental design that randomly assigned eligible villages of Huancavelica, the poorest department in Peru, to treatment and control groups, and organized special viewing sessions inviting all beneficiaries of Juntos, the Peruvian CCT program, in the eligible villages. A year later, we found that women who were exposed to the treatment have an improved knowledge and attitude towards formal savings, especially for precautionary motives. We did not find a significant change at the end of bimester savings balances until the July-August bimester, which we interpret as evidence that the improved pro-savings attitude remained latent for several months, until right about the time cash surpluses are likely, due to post-harvest season. In searching for the underlying mechanisms, we find no income effect, but a strong empowerment effect within the household, mainly for economic and financial decisions, and especially among the women under 40, which is also the group that shows more robust temporary savings effects. Overall, we interpret these results as evidence that the edutainment approach can have an important contribution to the financial inclusion of poor rural women that have faced secular exclusion from formal financial institutions like the ones from the Peruvian Southern Sierra.

Deploying eHealth across Europe to face depression

Introduction: Around 50% of those suffering a depression do not receive treatment and this is due to barriers such as lack of resources for mental health care or stigma related to mental disorders. Research shows that some of these barriers can be successfully overcome with ICT-based solutions among which Computerized Cognitive Behavioral Therapy (cCBT) has proven to be an effective and cost effective treatment for depression. Unfortunately the use of these ICT is still anecdotal in most regions and little is known about the potential health and economic impact of its generalization.Mastermind project is an EC co-funded project involving 23 partners of 11 European countries. Mastermind pretends to up-scale cCBT based interventions across distinct European regions and study the barriers and facilitators of the implementation process. In addition, a comprehensive evaluation process has been set up to study quantitative and qualitative indicators framed into seven domains: health problem, safety, clinical effectiveness, organizational aspects, economic aspects, patients perspective, socio/legal/ethical aspects.In the Basque Country 300 patients will participate in the cCBT intervention.Short description of the intervention: The integrated care based intervention deployed in the Basque Country aims to give a major role to the primary care professionals in the provision of care for patients with depression. The GP and GP practice nurse are responsible for identifying and recruiting patient fulfilling the inclusion criteria defined (&gt;18 years with mild or moderate depression diagnosed by the Patient Health Questionnaire-9).Once the patient accepts to participate in the project, the primary care team trains him/her in the use of the cCBT programme and provides him/her with the required username and password. During the online therapy, the patient has to fill different health related questionnaires (PHQ-9, BDI, Euroqol and MANSA-2) and go through 8 educational modules. Each module contains three sections: explanatory text, summary presentation and a video. The patient is supposed to read the text, revise the presentation and listen to the video in order to internalize the content of the session. Afterwards, the patient fills some specific exercises that are reviewed by the GP.During the online therapy, the primary care team are in charge of monitoring the progress of the patient and are supported by the nursing of the eHealth Centre, who work 24x7, in several tasks: phone calls to reinforce the adherence to the treatment, follow-up calls and activation of health resources depending on the final scores of the questionnaires (schedule an appointment in the GP office or specialist, activation of the ambulance).During the cCBT, the specialists (psychiatrists and psychologists) support the GPs in any decision-making when necessary. To do so, the GP solves clinical doubts via intercolsultations (messages via the EHR) or or via videoconference.Key findings:- The cCT programme has been collaboratively developed by the 4 Spanish regions within the project (Aragon, Galicia, Badalona and Basque Country) based on the existing scientific evidence. The programme has been adapted to their local requirements (language, culture and health care characteristics).- The four Spanish regions are deploying a similar organizational model in order to demonstrate the validity of both the online programme and the integrated care intervention.- Primary care professionals have to manage patients with mild and moderate depression, limiting the participation of the specialists to the most complex cases and severe depression. By this way, the waiting lists will be reduced in the mental health centers and primary care professionals are provided with a effective tool to improve their decision making.- Intense dissemination and sensitization efforts have been done to maximize the interest of health professionals and patients in the use of ICT resources as part of depression treatment.Highlights: (lessons learned)- Definition of the cCBT programme based on the requirements of both patient and professionals profile.- Need to reinforce the knowledge of primary care professionals in the clinicnal management of the depression.- Integration between distinct healthcare professionals (GP, GP practice nurse, specialists and eHealth Centre) is crucial to ensure an integrated care for patients with depression.- The duration of the online therapy has to be limited (eg. 12 weeks) in order ensure the engagement of the patient and guarantee the effectiveness of the therapy.Conclusions: The cCBT will be deployed in distinct regions trying to identify barriers and facilitators of the implementation process. The knowledge generated will be of paramount importance for future extensions of this type of care in a safe, efficient and effective way.

Pathways to improved development for children living in poverty

Conditional cash transfer programs (CCTs) have shown mixed effects on child development outcomes in the context of poverty. Direct parenting support integrated with CCTs may improve the effectiveness of CCTs for children’s development, and benefits could occur via improvements in parenting practices or the home environment. Here, we use data from a randomized effectiveness trial to examine the pathways connecting parenting support and child development. The parenting program (EI: Educación Inicial) was implemented at scale among beneficiaries of Prospera (a CCT, previously Oportunidades and Progresa). Participants included children between the ages of 3 and 5 years old (n = 1,362) from 91 rural communities in three Mexican states. Communities were stratified by indigenous classification and randomized to one of three arms: (T0) Comparison group (CCT benefits only); (T1) CCT benefits plus availability of EI in the community; or (T2) CCT benefits plus promotion and encouragement by the CCT program to participate in EI. Findings were that participation in the T2 arm of the study was associated with a 13% increase in the number of play activities that parents engaged in with their children, particularly shared storybook reading and singing. Parents in T2 showed nearly two times greater odds of reading daily to their children. In mediation analyses, the amount of play activities and shared book reading explained up to 32% of the effects of the EI parenting program on child development outcomes. In this study, collaboration and integration of two social programs was critical for program impact, which occurred through pathways relating to parental engagement in reading and play.

Household Responses to Cash Transfers

This paper estimates a collective model of the household and investigates how parents reach decisions to allocate household resources. Using data from PROGRESA, we test the restrictions of collective rationality on a large variety of specifications and show that, contrary to previous results, this modeling approach cannot rationalize the household decision process. We provide some evidence that the observed inefficiency is driven by the group receiving the cash transfers. These results are consistent with the idea that a possible indirect effect of CCT programs may be to enhance disagreements between the spouses which trigger an inefficient allocation of their resources.