114 CHAPTER 7


creating incentives for children’s visits to health centers. The limited impact of PATH on immunization may have been because the immunization rates of both beneficiaries and nonbeneficiaries were high at the outset. Forty-six percent of the families that took their children to health checkups more regularly said they did so because of the PATH requirement, and the majority reported “change in health circumstances” (Levy and Ohls 2007, 76, 80). Mexico’s PROGRESA required beneficiaries to visit public clinics for


preventive health visits. Depending on the regression specification used, PROGRESA beneficiaries averaged 2.09–11.49 more visits per day to clinics in PROGRESA areas compared to those in non-PROGRESA areas.2 The lower estimate represents about 18 percent more visits—by both beneficiaries and nonbeneficiaries—to clinics in PROGRESA areas compared to control areas. If all the increase were attributed to PROGRESA beneficiaries, visits would have increased by roughly 60 percent among this group. Because beneficia- ries represent roughly 20 percent of the total number of families in PROGRESA service areas, the impact estimates suggest that beneficiary visits increased twice as much as visits by non-PROGRESA families (Gertler 2000, 10; Gertler and Boyce 2001, 11). Disaggregating the visits to public and private clinics indicates that the


use of public clinics increased by 53 percent overall. There was no reduction in the use of private health providers, suggesting that increases in the use of public clinics was not a result of substitution of public care for private care (Gertler 2000, 12). PROGRESA increased the number of growth monitoring visits by benefi- ciary children from birth to age two by 30–60 percent and those of children ages three to five by 25–45 percent, based on different regression models (Gertler 2000, 13).3 Additionally, PROGRESA resulted in an 8 percent increase in initial prenatal visits during the first trimester of pregnancy. This focus on earlier prenatal care reduced the number of initial visits in the second and third trimesters of pregnancy, a behavior change that is recognized to improve the health of pregnant women and their infants (Skoufias 2005, 56). Figure 7.1 summarizes the results on health service usage.


Health Outcomes Only the CCTs in Colombia and Mexico show evidence of impacts on health outcomes. Other program evaluations either did not measure this (those in


2The smaller figure comes from a regression using a dummy to indicate whether the facility was located in a PROGRESA service area; the larger figure emerges from a regression using the num-


ber of families in the service area receiving PROGRESA benefits (Gertler and Boyce 2001, 10). 3One model adds per capita income to try to separate the transfer income effect from the impact of the nutrition and preventive care (Gertler 2000).


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