108 CHAPTER 7


illness.1 The most significant impact (a change of 14.2 percentage points) occurred among the elderly (older than age sixty-five), who experienced the highest rate of morbidity at baseline (82 percent). Children under age five and adults of productive age (nineteen through sixty-four) also experienced a reduction of 12 percentage points in the incidence of illness. The evaluators speculate that this was probably due to improved nutrition and hygiene (Zam- bia, MCDSS/GTZ 2006, 43). The 2008 evaluation results from Malawi’s Mchinji Cash Transfer indicate that there were improvements in the health status of both children and adults. After the program had been in place for one year, the number of adults who reported being ill in the previous month had fallen by 21 percentage points among intervention households (from 80 to 59 percent) compared to 8 per- centage points for comparison households (from 81 to 73 percent) (Miller, Tsoka, and Reichert 2008, 23). Similar gains were noted among children. The number of children under age eighteen who were sick in the month before the survey was 13 percentage points lower among intervention households than in com- parison households (42 versus 55 percent). The evaluation results also showed a difference in the percentage of change in child illness. In intervention house- holds, 23.4 percent fewer children experienced illness in the previous month ver- sus only 12.5 percent fewer children in comparison households. Intervention households were also more likely than comparison households to report that their children had excellent health (31 versus 13 percent) and less likely to report that their children had poor or fair health (13 versus 33 percent). Among intervention households, 81 percent reported that their children’s health had improved from March 2007 to March/April 2008 compared to 15 percent among comparison households. At the same time, 3 percent of intervention house- holds said their children’s health had worsened compared to 14 percent of com- parison households (Miller, Tsoka, and Reichert 2008, 26).


Spending on Health In the absence of impact data on access to health services, health service use, or health outcomes, some evaluations have used documented changes in household spending on health as indicators of likely health impacts. The results should be interpreted cautiously, however, because high or increased health spending after receiving a transfer can have very different meanings. Although increased spending could indicate improved access to services, it


1Illnesses included measles, malaria, tuberculosis, AIDS, asthma, bronchitis, diarrhea, vomiting, anemia, abdominal pains, skin infections, pneumonia, a cough, eye and ear infections, high blood pressure, chest pain, toothaches, mouth infections, and backaches (MCDSS/GTZ 2006, 43).


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