SUMMARY xv
types of indicators. Again, health service challenges will be even greater in Sub-Saharan Africa. At the time of this writing, only a few rigorous evaluations of UCTs in
southern and East Africa had data available; other studies had smaller sample sizes or weaker control groups. However, several have demonstrated substan- tial positive impacts on the well-being of families and children. These results come from modeling using large national datasets in South Africa and empir- ical studies at the provincial, district, or subdistrict level in several countries. The main impacts demonstrated in South Africa have been on school enroll- ment. Significant gender discrimination in schooling decisions in some coun- tries indicates that it is critical to pay attention to gender issues in designing programs. There may also be some impacts on schooling via the spending of cash transfers on school expenses. Grant expenditures on food could also have an indirect effect on schooling via nutrition and health improvements, although these studies did not examine this impact pathway. Old age pensions have also been found to support children’s education and nutritional status. However, pensions will miss children in households without elderly residents. A grant for households with children will better ensure that children have grant access. UCTs have had some impacts on self-reported health status in several countries, and there is some limited evidence of impacts of UCTs on nutritional status, though they were not directly assessed in most evalua- tions. UCTs were largely spent on food; in most of the programs evaluated, grants were associated with self-reported reduction in hunger and an increase in the average number of meals per day, and in some countries they were associated with an increase in dietary diversity. Analyses of existing cash transfer programs and country simulations demonstrate that these programs have the potential to reduce poverty, particularly the poverty gap and the severity of poverty, if they are well targeted. The impacts on the poverty headcount tend to be smaller. No other social protection mechanism has yet demonstrated these impacts through well-designed impact evaluations. Targeting transfers in the context of HIV and AIDS involves decisions
around who most needs benefits—whether to target only directly AIDS- affected families or the broader population of poor families and what criteria and methods to use to best reach different target groups. Where cash trans- fers are not rationed and available to all who are eligible, poverty criteria alone are sufficient to reach AIDS-affected households. In countries such as Malawi and Zambia, where the grants are rationed to 10 percent of a given community, reaching AIDS-affected households requires overlaying poverty criteria with proxy indicators of AIDS-affected households, such as labor con- straints, illnesses, and high dependency ratios. An alternative approach is to target the elderly as a means of reaching children, including orphans. How-
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