The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia

Abstract

Objective: Conditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment. Design: Secondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas. Setting: Colombia. Subjects: Children (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities. Results: Familias en Accion was associated with a significant increase in the probability of using preventive care services (OR = 1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (β = 1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas. Conclusion: CCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.

Special Report: The Biology of Inequalities in Health: The Lifepath Consortium

“…Cash transfer programs pursue the twin objectives of reducing immediate financial hardship while promoting parental investment in their own and their children's health and wellbeing. However, CCT programmes are very specific in their impact, only providing benefits associated with each programme's conditionalities (41). There may not be a "spill-over" effect to broader determinants of children's health, and programmes should be better designed to motivate parents and families to invest in the wider determinants that affect children's health (41,42).…”

“…Among children in Colombia, conditional cash transfers increased contact with preventive services, improved dietary diversity scores and reduced risk of thinness, but they also increased body mass index (41,42). Overall, the positive effect of conditional cash transfers appears to be more consistent in the context of a middle-income country such as Colombia, where the risk of poor nutrition and reduced access to care is still prevalent and higher than in the context of the United States, where effects of the programme were weaker.…”

Subsidized Health Care and Food Security: Evidence from Colombia

“…Nevertheless, the results present no evidence of any mediation effect from these programs, contradicting previous evidence. For example, Attanasio and Mesnard (2006) and Lopez-Arana et al (2016) provide evidence that Familias en Acción-a cash transfer program for very poor households that also provides supplemental nutrition to children, conditional on school attendance and regular medical check-ups, has a positive effect on food consumption.…”

Evaluation of a facility location for a food assistance supply chain. The case of Bienestarina in Colombia

“…One of the strategies to fight malnutrition is the continuous supply of food to the vulnerable population. That approach delivers food or complementary feeding to enhance the ingest of high nutritional value nourishment (Lopez-Arana et al, 2016). Other strategies are the direct cash transfers to the target population or the indirect cash transfers for alleviating the cost of the food and increasing the variety of consumer products (De Groot et al, 2017).…”