68 CHAPTER 4


pared a supply-side grants-to-schools intervention with one that combined these grants with an educational allowance for students. It found that the supply-side intervention alone had no significant impact but that the com- bined intervention had a large impact on school enrollment (Ahmed 2006; see Chapter 6 for more details).


The idea of conditioning on a nonexistent service is unlikely, so the supply- side concern is sometimes overstated. Where it becomes problematic is with respect to capacity, distance, transportation, supplies, and quality, where “access” becomes more subjective. The other problem concerns geographic targeting: if only regions with service access become part of the CCT, people who are already most disadvantaged, those living in the poorest, least served areas, who are also most likely to need the cash transfer, will not receive the program. Program designs can adapt in other ways to supply constraints, however. For example, in the pilot CCT that was proposed in Uganda, the conditionality does not apply to the elderly, the disabled, others with mobil- ity problems, or those long distances from schools or clinics (Uganda, MGLSD 2007).


There is, however, another side of the supply argument. Precisely because


CCTs require adequate services, they can serve as a strong impetus for in- creasing the quantity and quality of services, putting pressure on govern- ments and their respective departments to increase supply. CCTs are often joint undertakings by ministries of social development or welfare, education, and health, requiring intersectoral collaboration; in fact, the ability to achieve this is another prerequisite for a CCT. Farrington and Slater (2006) argue that conditionality may not promote increased supply because health and education services remain largely in the public domain, which is less re- sponsive to demand. Although this may often be true, ministries of health and education are participating in CCTs in many countries. In Nicaragua, the Red de Protección Social “forced” important supply-side improvements (Maluccio, Murphy, and Regalia 2006). Honduras’s CCT program, Programa de Asignación Familiar (PRAF), consisted of two “packages,” a demand-side package of con- ditional transfers to families and a second package called “supply-side incen- tives” consisting of cash transfers to healthcare provision units—conditioned on their undertaking quality improvements—and to the schools. Teachers also participated in a continuous training program to improve their teaching of math and Spanish (IFPRI 2003b). Nicaragua’s supply-side component was suc- cessful; Honduras’s was not, which was, in part, responsible for the low impacts of the latter country’s CCT program. In Nicaragua, where the govern- ment health services could not meet new demand, NGOs were contracted to supply health services and monitor participation. Because of the large pres- ence of NGOs in the health sector in Africa already, they are likely to play a


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