58 CHAPTER 4


deficits, and objectives, and many countries around the world indeed share similar problems, for example, discrimination against girls in schooling deci- sions. However, different countries have different levels of achievement and different failings with respect to human capital and other objectives, as well as different factors contributing to poverty. As seen in Chapter 6, the reason that CCT programs in several countries had very low impacts on primary school enrollment was that enrollment levels were already very high before the program. Primary school enrollment does not need to be a condition of a CCT as often as it is. There are often regional variations, in which, for exam- ple, primary enrollment is high nationally but very low in some parts of the country, as is the case in Turkey, which had a national CCT for primary (as well as secondary) school. Variations may also occur within countries across groups defined by gender, ethnicity, age, or other variables. CCTs can be designed to respond to these differences. Relevant design differences can also respond to the nature of shocks; HIV


and AIDS are key examples of shocks in Sub-Saharan Africa. In Lesotho and Tanzania, CCT studies have been planned to condition on testing negative for sexually transmitted diseases (STDs) (Özler and de Walque 2009). In India, a small program conditions benefits on delaying marriage to age eighteen and completing school (Chaudhury 2007). In Malawi, a study found that incentives in the form of cash transfers and school fees reduced early marriage, teenage pregnancy, and self-reported sexual activity among adolescent girls (Baird et al. 2009). In South Africa, a study is under way to determine the effectiveness of a CCT in promoting schooling and reducing risky sexual behavior and HIV/ AIDS risk among young girls (Pettifor and MacPhail 2009). There is growing interest in developing conditional programs with early childhood develop- ment services (World Bank 2006a, 36). Conditioning cash in some form has been used to create incentives for behavior change in the area of sexual and reproductive health in Bangladesh, India, and the United States, and small studies have experimented with incentives for participation in HIV/STD pre- vention counseling and steps related to treatment goals (Kamb et al. 1998; Petry, Martin, and Finocche 2001, cited in Medlin and de Walque 2008; Maul- don 2003). More recently, a small program examined the impact of mone- tary incentives and costs on obtaining HIV test results (Thornton 2008). Given some successes in this area, it is a concept worth pursuing. However, these are areas that must always be approached very carefully. Depending on the outcomes pursued and the indicators needed to determine achievement of the desired outcomes, particular complications with respect to feasibility and ethics may be introduced where HIV prevention is the objective (Medlin and de Walque 2008).


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