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health behaviors and outcomes. This gap applies to CCTs as well as UCTs. In the case of CCTs, the impact could be a result of the cash itself (income effect), price changes effected by conditionalities (price effect), or both. Alternatively, the impact could derive from the fact that transfers are made to women, who have been found to spend a larger share of income they con- trol on children when compared to men. Or the social marketing accompany- ing cash transfers, even in the absence of conditions, could affect the use of cash. Furthermore, CCTs often require monthly participation in health train- ing workshops. These could certainly affect health behaviors, and qualitative evidence suggests that they do but that strong sociocultural influences also limit the effectiveness of CCTs (Adato, Roopnaraine, and Becker 2011). Unfortunately, data that would allow us to tease out the relative effects
of these different pathways are not available, so we cannot draw conclusions about the value of health conditionalities or about the relative value of dif- ferent components of program designs. Unlike in the case of education, there are not yet any findings on healthcare outcomes using accidental experiments comparing transfers believed to be unconditional with those thought to be conditional (see Chapter 4). We can conclude, however, that UCTs have resulted in improved access to healthcare services in several countries (Malawi and South Africa) and improved health status (self-reported illness and health status) in several others (Malawi, South Africa, and Zambia). Whether these impacts could have been larger if accompanied by a health conditionality is unclear. Whether conditionalities in their current form are even relevant, given the main healthcare priorities of AIDS-affected families (for example, going to the clinic for ART), is another open question. Withholding cash from people at advanced stages of AIDS because they did not go to the clinic seems unethical, but one could design a program whereby beneficiaries would receive cash when they picked up their drugs (as is currently often the case with food) as a conditionality. However, the main objective of CCTs has been to protect the health of pregnant women and children, and AIDS-affected families need this type of protection every bit as much. Several evaluations under way (for example, in Kenya and Uganda) that compare a conditional and unconditional program may shed light on this question; however, further studies focusing specifically on healthcare uptake as well as effects on health service provision would be valuable.
In the absence of additional evidence, and given the positive results of several UCT programs in Africa in countries with a high HIV prevalence, UCTs appear to be a promising start to improving health outcomes among AIDS- affected communities. Apart from some of the indicators reported earlier, the access these programs provide to food is likely to contribute to health impacts. However, further examination of conditionality in contexts of high HIV preva-
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