CASH TRANSFERS AND HEALTH 109
could also signify increased need for healthcare services. At the same time, low or decreased spending could indicate limited access to healthcare ser- vices or a reduced need. Health expenditures among Zambia’s SCTS beneficiaries fell from baseline
to evaluation, perhaps indicating that spending priorities had changed or that there was less need for health-related spending because illness prevalence had decreased (Zambia, MCDSS/GTZ 2006, 49). At evaluation, beneficiaries spent an average of 1.2 percent of the transfer on health but 13.2 percent on hygiene products, which could have made some contribution to improving their health (Zambia, MCDSS/GTZ 2006). Similarly, health spending in South Africa fell slightly in the presence of social grants, by just under 1 percentage point for the OAP and just under 0.025 percentage point for the CSG (Samson et al. 2004, 76). Again, this may be because social grants promote better nutrition and education outcomes, which can lead to better health outcomes, making medical spending less necessary. Croome (2006) found that elderly pensioners in Lesotho spent more on
health (hospital or clinic visits and medicine) after they received the transfer compared to before and that, overall, beneficiaries used an average of 8 percent of their pension income on health (Croome 2006). The Namibian social pension provided N$160 per month to the elderly over age sixty, an amount estimated to be sufficient to feed three adults, on average (Devereux 2001, 43). Of the total pension, 13.8 percent was dedicated to pensioner health expenses. Only 28 percent of total pension income was spent on pen- sioners themselves, with the remainder going to the household or relatives. Grandchildren were the largest group of secondary beneficiaries, receiving more than half of the remaining pension income (55 percent), followed by adult children (25 percent) and spouses (9 percent) (Devereux 2001). According to the 2006 evaluation of Ethiopia’s PSNP, 29 percent of benefi-
ciaries spent some of their cash benefits on health (Devereux et al. 2006, 34). Of these beneficiaries, the poorest were almost twice as likely to use PSNP cash to pay for healthcare (56 percent in the two poorest quintiles versus 23 percent in the two richest quintiles) (Devereux et al. 2006, 35). Three quarters of all households receiving the Mchinji Cash Transfer in
Malawi spent some of the transfer on healthcare (Miller, Tsoka, and Reichert 2008, 40). According to data from September 2007, the average expenditure represented 12.3 percent of the monthly transfer (Miller et al. 2007). A 2007 evaluation of Kenya’s Cash Transfer for OVC found that 37 percent
of beneficiaries spent part of their transfer on medical fees, with the average expenditure on health equivalent to 6 percent of the cash transfer. The report also noted that HIV-positive children received ARV treatment, which they had
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