Assessing the Need and Opportunities for Improved Linkages between Conditional Cash Transfers and Reproductive Health Programs in Latin America and the Caribbean

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-98-00012-00. The contents are the responsibility of the FRONTIERS Program and do not necessarily reflect the views of USAID or the United States Government. SUMMARY Conditional cash transfer (CCT) programs provide cash to poor households, mostly in rural areas, on the conditions that children stay in school until they finish a minimum level of education established by the program, and that children and mothers attend health centers and educational sessions. CCT programs are based on the assumption that poor families do not invest enough in human capital and are therefore trapped in a cycle of intergenerational transmission of poverty. Currently 14 countries in Latin America and the Caribbean (LAC) have CCT programs. Countries in Africa and Asia have also begun programs in the last few years The objective of this project was to document the structure and functioning of CCT programs in LAC, to assess opportunities for improved linkages between CCTs and reproductive health programs, and to explore the role that operations research may have in the improvement of CCT programs. The activities conducted included: 1) a desk review of the CCT programs in the Dominican Republic, El Salvador, Honduras, Jamaica, Nicaragua and Peru; 2) a review of the literature on CCT programs; and 3) on-site visits to El Salvador, Honduras, Jamaica, Nicaragua and Peru to interview key informants and assess their perceptions of the functioning of the CCT programs and opportunities for improving them. The greatest opportunities to improve the reproductive health outcomes of CCT programs were establishing systematic screening procedures for a minimum package of essential preventive services, including contraception. Increasing access to sterilization and the IUD for CCT program beneficiaries and establishing community-based distribution to increase access to temporary methods also have great potential. The model of offering a bonus for institutional births used in Honduras should be tested in other programs. Other opportunities include testing a reduced schedule of visits, strengthening linkages between school and health service activities and establishing positive deviance interventions to achieve better outcomes in reducing anemia in children of beneficiary families. Operational problems faced by CCT programs included the targeting and selection of beneficiaries, monitoring compliance with conditions for receiving cash transfers, the systems used to provide the transfers, and management weaknesses. Recommendations …