Increasing the cash transfer component of Mexico's Oportunidades programme is associated with better outcomes in child health, growth and development. These are the conclusions of authors of an Article in this week's edition of The Lancet.
Worldwide, more than 200 million children under the age of five year are not fulfilling their potential for growth, brain function, or socioemotional development. As they grow up, children living in poverty in the developing world are likely to have substantially lower wages than do healthier adults, and this poverty trap is likely to be perpetuated in their own children. The question of how to intervene to improve child health and wellbeing is of paramount importance. Many governments in developing countries, particularly Latin America, have turned to conditional cash transfer (CCT) programmes to address the larger issue of poverty alleviation. Families qualify if their income falls below a certain level or if they live in a defined geographical area -- and they only receive the payment if they comply with certain requirements. For example, in most CCT programmes the payment is conditional on mandatory attendance at preventive-health care services and health and nutrition education sessions, and some also require school attendance for school-age children.
Dr Lia Fernald, School of Public Health, University of California, Berkeley, CA, USA, and colleagues looked at Mexico's Oportunidades programme* (previously called Progresa) , which began in 1998. A total of 506 low-income communities were randomly assigned to be enrolled in Oportunidades immediately or 18 months later. A total of 2449 children aged 24-68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes.
The researchers found a doubling of cash transfers to the household was associated with improvements across the board in children; an approximate one centimetre increase in height; a 10% lower prevalence of stunting; a reduction in the age-adjusted body-mass equivalent of a little less than half-a-pound, and an 8% reduction in the prevalence of being overweight.
The authors conclude: "Our results suggest that the household cash transfer component of a large-scale CCT programme is associated with critically important child health, growth, and development outcomes, including height for age, stunting, being overweight, several measures of cognitive development, and language development. Our findings support the notion that Oportunidades is achieving its objectives in these domains via cash transfer." The authors are careful to point out that the cash transfer is likely to work in tandem with other Oportunidades programme components such as health care, nutrition supplementation, and nutrition education.
In an accompanying Comment, Dr Kenji Shibuya, WHO, Geneva, Switzerland, says: "CCT could be combined with ongoing efforts to enhance the provision of health services to poor people in many low-resource settings -- through performance-based funding and health-systems strengthening -- and simultaneously introduce behavioural changes and incentives."
*notes to editors: see p829-830 of full Article for details of Oportunidades programme
Dr Lia Fernald, School of Public Health, University of California, Berkeley, CA, USA T) +1 (415) 577-5423 E) fernald@berkeley.edu
Dr Lynnette Neufeld, Division of Nutritional Epidemiology, National Institute of Public Health, Cuernavaca, Mexico, T) +52 777 329-3016 E) neufeld@insp.mx
Dr Kenji Shibuya, WHO, Geneva, Switzerland T) +41 22 791 2370 E) shibuyak@who.int
PDF OF ARTICLE: http://multimedia.thelancet.com/pdf/press/Mexico.pdf
Journal
The Lancet