CASH TRANSFERS AND HEALTH 107
orphaned children in Namibia, South Africa, and Zimbabwe live with their grandparents, as do more than 50 percent in Botswana, Malawi, and Tanzania. The responsibility of elderly caring for orphaned children is increasing as the AIDS epidemic advances. For example, in Namibia between 1992 and 2000, the overall percentage of orphans living with their grandparents increased from 44 to 61 percent (UNICEF 2003; Gorman 2004, 18). Children and adults in a household are likely to benefit if the pensioner is healthier and therefore better able to provide care and to improve living standards in the household (for example, through food and healthcare expenditures for all, being able to afford piped water, and so forth). In South Africa, Case (2001) compared the self-reported health status of adults living with pensioners with that of adults living without pensioners. She finds that pension income (at R520 per month) had a positive impact on the health of all adults in households that pooled their income but only on the health of pensioners in households that did not pool their income. This is consistent with the expectation that in non-income-pooling households pension- ers would use a larger share of their pension for personal use, including health needs. Indeed, in income-pooling households, every adult in the household expe- rienced an improvement in health status of 0.5 points on a five-point scale, while in non-income-pooling households pensioners benefited by a full point. The num- ber of non-pension-receiving household members was not associated with health status in income-pooling or non-income-pooling households (Case 2001, 7–10). Case also explored the mechanisms by which pension income improved health status. In response to open-ended questions, some beneficiaries reported using the pension to purchase more food, and some said they upgraded house- hold facilities through the purchase of paraffin stoves, phones, or improved kitchens, some of which can have consequences for health (Case 2001, 12). Having a pensioner in the household was positively and significantly corre- lated with the presence of a flush toilet in the home and negatively correlated with an off-site household water source, and the likelihood of having a toilet increased significantly as the duration of pension receipt increased (Case 2001, 14–15). Samson et al. (2004) report a similar finding about piped water: the amount of the OAP and receipt of a Disability Grant were significantly associated with a higher probability that the household had access to piped water (Samson et al. 2004, 85), an amenity that can affect the health of adults and children in the household. According to the 2006 evaluation of the SCTS in Zambia, the incidence of illness among SCTS beneficiaries declined between the baseline and the follow- up evaluation. At baseline, 43 percent of beneficiaries reported having some illness, and by the evaluation one year later, only 35 percent reported an
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