CASH TRANSFERS AND HEALTH 113


however, provide evidence on another issue in the conditionality debate, that is, the implementation difficulties that can be encountered as a poor country attempts to improve the supply of services. Nicaragua provides a contrary ex- ample, however, because it was able to successfully improve supply. In Nicaragua, RPS resulted in an increase in the percentage of children


under age three making well-child visits, with an average increase of 16.3 percentage points in 2001 and 8.4 percentage points in 2002. The reduction in impact measured in the second year was due to more visits among the control group in 2002 (10.5 percentage points) and only a slight decline in intervention areas. There was also a 13.1 percentage point double-difference estimate of the percentage of children taken to healthcare providers and weighed. From 2000 to 2002 the control group increased their visits to health- care providers by 15.2 percentage points, whereas beneficiary households increased their visits by 28.3 percentage points, nearly double the increase in the control group. Several hypotheses exist to explain the increase in con- trol group usage of health services. It could have been because other provid- ers established new healthcare services in the area; because RPS drew bene- ficiary families away from public clinics, reducing the waiting time and making these health centers more inviting to control households; or because control households increased their use of services in anticipation of the CCT (Maluc- cio and Flores 2005, 24, 44). Impacts on both visits to health centers and growth monitoring were


larger among poorer RPS households. Extremely poor households experienced an increase of 29.9 percentage points in the weighing of children from birth to age three in the previous six months compared to poor households, which experienced an increase of 23.5 percentage points. Effects for children ages three to five were even greater than those for children from birth to age three (Maluccio and Flores 2005, 45–46). In Colombia, Familias en Acción brought about significant increases in pre- ventive healthcare visits. Attendance of growth monitoring and development checkups, in which children are weighed and mothers receive child nutrition advice, increased by 22.8 percentage points for children under twenty-four months of age and by 33.2 percentage points for children ages twenty- four through forty-eight months (Attanasio et al. 2005, 10). In Jamaica, PATH increased the average number of preventive healthcare


visits for children from birth through age six by approximately 38 percent (or 0.28 visits every six months) but had no impact on child immunization rates or on healthcare use by the elderly (age sixty or older) (Levy and Ohls 2007). This difference may have been because compliance with health conditions was not enforced for the elderly but was frequently enforced for children,


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