110 CHAPTER 7


not been able to afford before the cash transfer program, and that some adult beneficiaries, 30–50 percent of whom were HIV-positive or had developed AIDS, used the transfer to purchase ARVs (Acacia Consultants 2007, 16, 24).


Impacts of Conditional Cash Transfers on Health As in the case of education, many CCT evaluations assess the impact of pro- grams on beneficiaries’ use of preventive health services. Although the coun- tries with CCT evaluations have very low HIV prevalence rates, it is none- theless valuable to investigate program impacts on health—and trends in the types of impacts—achieved by these programs to get a sense of the range of possible impacts associated with different types of programs. Among the docu- mented health-related impacts of CCTs, there is more evidence of changes in the use of services (that is, health checkups and growth monitoring) and less evidence of changes in health outcomes, such as illness prevalence. Table 7.2 and Figure 7.1 summarize health-associated impacts of CCTs in five countries.


Use of Preventive Health Services The Honduras PRAF evaluation compared three types of CCT interventions: the demand-only intervention involved cash transfers contingent on attendance at health centers, growth monitoring, and school; the supply-only interven- tion involved the improvement of health and education services; and the demand plus supply intervention involved a conditional transfer along with service improvement. Beneficiary groups receiving each of these interven- tions were compared to a control group that did not receive any intervention. The impact evaluation showed that the type of intervention affected changes in health service use. For example, the percentage of children under age three who visited healthcare provision units increased by 21 percentage points under the demand-side intervention (a 45 percent relative increase) and 15 percentage points under the demand plus supply intervention. This effect did not vary by child age. The supply-only intervention had no impact on health- care visits.


PRAF impacts on beneficiary participation in child growth monitoring and


prenatal visits followed the same pattern according to type of intervention. The percentage of children under age three attending growth monitoring as reported by mothers increased by 22 percentage points under the demand- side intervention and 17 percentage points under the demand plus supply inter- vention. Again, the impact was consistent across all ages. Although atten- dance remained stable under the supply-only intervention, this represented an improvement over the control group, whose attendance decreased. Admin- istrative data (from Tarjetas del Niño, or Child Cards) showed a smaller impact than did interviews with mothers, but the relative changes remained the


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