As all known, conditional cash transfer (CCT) programs intends
to reduce poverty by
making welfare programs conditional upon the
receivers' actions. The money is transferred by the government only to the
persons who meet certain criteria such as enrolling children into public
schools, getting regular check-ups at the doctor's office, receiving vaccinations,
etc.[1]
Elizabeth Fitzgerald from Harvard
University brought up her concerns about CCT programs. To her, in order to make
a healthy evaluation of CCT programs, one should consider the ways in which
cash transfers impact health.
One
proposal is that, the additional income of the cash transfers allows participating
families to purchase higher quality food, health care services, and etc. Investing
in household improvements, assets, and entrepreneurial activities, or buying
books and toys to stimulate child development would lead to a positive impact
on the health of children in these families.
Additionally,
since cost is seen as a barrier to utilization of nutrition and health care, monetary
assistance is believed to improve poor families’ health. However, there are
other barriers which may limit the successes of some conditional cash transfer
programs.
CCT
programs do not say anything about the quality of care. Higher school
enrollment rates and attendance do not necessarily translate into higher
earnings or increased learning. According to the report conducted by World Bank
in 2009 on CTT programs around the world, improved education has very small effect
on living wage earnings. If the health care and education provided with
beneficiaries are not high quality, future health outcomes are quite limited.
If increased use and access are not enough for improved child health outcomes, the
issue may lie with supply-side infrastructure and inefficiencies. Studies
conducted around the world found that supply-side issues have a strong effect
in many countries. The most conspicuous supply-side issues identified include
inadequate supplies, a limited capacity for management, financing, and
expansion of health and education services, geographical inaccessibility to
services, scarcity of teachers and health professionals especially in rural
areas. Constructing roads and health centers in rural areas, better monetary
incentives for rural workers, and performance based incentives for healthcare professionals
for improved healthcare quality may be some potential solutions.
Conditional
cash transfer programs can be customized for different countries to fit their
needs. Governments and aid organizations evaluate the health care and
educational infrastructure of a country before they design conditional cash
transfer programs for it. In many low-income and developing countries, initial
investments to improve underlying systems would result in increased impacts on
the overall health of the country in the long run.
The key
thing here is, governments and aid agencies should consider the underlying
system and infrastructure of a country and supply-side improvements in order to
design successful conditional transfer programs. Otherwise, it would make no
sense to allocate money for these Programs.
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