Conditional cash transfer programs are helping
governments deliver health care to the neediest citizens,
while ensuring greater government accountability.
REACHING The Poor
by Amanda Glassman
Conditional cash transfer (CCT) programs are now widespread in Latin America. Fifteen countries run CCT programs, benefiting approximately 100 million people and
21 million households.
These programs address market
failures associated with low investment in human capital for the poor.
Although their structure differs by
country, CCTs generally transfer cash
to poor mothers once they have accessed certain public programs such
as preventive health services and ensured school attendance for their
children. The programs also provide
counseling and education on better health and nutritional practices.
In effect, CCTs combine short-term
transfers for income support with incentives for long-term investments
in human capital.
By transferring resources directly
to poor households—generally 10
Accountability
By increasing demand and re- vealing gaps in quality and availability, theseprogramsin-directly generate political pressure
to improve public services.
Overall, CCT programs are extremely progressive. The majority of
benefits do reach the poor [see ta-
percent to 30 percent of a household’s average monthly spending—
CCTs intervene on the demand side
to change relationships between
health service users, service providers and governments. They do not directly intervene on the supply side;
but they indirectly address market failures, such as disincentives
for coordination and information
asymmetries by producing detailed
information on gaps in the supply
of health and education services to
marginalized populations.
ble]. There is some leakage to wealthier groups, but this is a problem for
any kind of income proxy means test.
Looking specifically at health
care, without any intervention, the
use of public health services by the
poor is low and health outcomes are
highly unequal between the poor
and the rich. In Nicaragua, for example, 2006–2007 survey data indicate that stunted growth affects
only 6. 1 percent of children nationally, but 11 percent of children from
the country’s poorest quintile. 1 Likewise, in Honduras, 2005 data show
that stunting is high at 25 percent of
children nationally and a shocking
43 percent for children in the poverty income bracket. 2
The development implications of
these health inequalities are substantial. Improved nutrition in early childhood leads to better adult human
capital including larger body size, im-
