CONCLUSIONS 167


reduced the incidence of illness, although evidence of the latter is weaker than that of the former. CCTs have achieved strong results with respect to increases in the quantity and quality of food consumption and improvements in nutritional status, although the latter varies considerably across countries and types of indicators. Like education, health service quality, particularly for certain kinds of services such as prenatal care, is a huge challenge and limits impacts (Morris 2010). Again the challenge will be even greater in Sub- Saharan Africa. Although most of the Latin American countries producing the reported


CCT impacts have better infrastructure, services, and administrative capaci- ties than do most countries in Sub-Saharan Africa, strong CCT impacts have been achieved in some very poor countries with low levels of infrastructure and implementation capacities, such as Bangladesh and Nicaragua. Design and implementation approaches have been adapted to different country condi- tions, capacities, and objectives. UCTs, with a growing presence in eastern and southern Africa, have also demonstrated substantial positive impacts on the well-being of families and children. These results come from modeling using large national datasets in South Africa and empirical studies at the provincial, district, or subdistrict level in several countries. The main impacts demonstrated in South Africa have been on school enrollment. Significant gender discrimination in schooling decisions in some countries indicate that it is critical to pay attention to gender issues in designing programs. One approach is through a hard or soft conditionality for girls’ schooling, although this must be considered in light of whether other con- textual factors make conditionality feasible or appropriate. One option might be to offer a supplemental grant if all girls are in school. There may also be some impacts on schooling via the spending of cash transfers on school expenses. In all southern African countries in this review, the largest grant expenditures by far were on food, which could also have an indirect effect on schooling via nutrition and health improvements, although these studies did not examine this impact pathway. OAP spending on educa- tion in several countries, modeling exercises comparing grant modalities, and evidence of pension-driven enrollment effects found in South Africa suggest OAPs are one way of supporting children’s education. Evidence from South Africa also suggests that cash transfer programs targeted to the elderly (par- ticularly women) can have a positive impact on children’s nutritional status. However, pensions will miss children in households without elderly residents and will be lost if the recipient passes away. A grant for households with chil- dren will better ensure that children have grant access. There is no evidence yet, however, establishing what type of grant income ultimately leads to chil- dren’s well-being across different measures.


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