70 CHAPTER 4


Poorer countries with less capacity could adopt simpler designs, with fewer conditions or “soft conditions” that are encouraged but not enforced. Benefi- ciaries can sign a paper or consent by oral agreement to meet conditions, with no sanction carried out if they do not. Exemptions can be made for people who cannot meet the conditions. Another approach is to link cash transfer programs to complementary but not required activities, for example, service delivery, receipt of information, or training (discussed further in Chapters 6–9).


Conclusion This chapter reviews the key issues that policymakers must consider in deter- mining whether to condition cash transfers. Although most of these debates have thus far played out in the Latin American context and others in which HIV/AIDS does not figure into their resolution, each issue has relevance for Sub-Saharan African countries. The primary issues are (1) designing conditions appropriately and contextually to specific priority objectives, including affecting the prevention and mitigation of HIV and AIDS; (2) whether there is likely to be added value from conditioning; if not, the additional burden of administering the conditionality, coupled with the risks of reducing access to urgently needed cash if program administration is slowed or if families can- not or do not comply with conditions; (3) power dynamics, that is, the power relationships altered by CCTs; (4) political economy considerations, that is, whether conditionality, requiring something in return for the money, makes the programs more acceptable to the middle class and treasury officials; and, perhaps of highest relevance in the near term, (5) the potential of Sub- Saharan African countries to cope with CCT demands for administrative capac- ity, service availability, and costs. The first issue with respect to design is where the greatest challenges


arise in the context of HIV and AIDS. Rather than simply conditioning on school attendance or clinic visits, as in the traditional CCT design, a number of experiments are under way to try to achieve HIV prevention objectives. With respect to human capital impacts, the information is simply not yet there to allow us to make a determination on the added value of conditional- ity; this calls for carefully run small pilot programs to determine whether conditionality contributes impact beyond the cash. Furthermore, although conditionality in the African programs has thus far not been required to gain the political support needed for pilot programs and limited scaling up, the difficulties some countries have faced (for example, Uganda and Zambia) in winning high-level support for national programs suggests that conditionality may someday be introduced. In South Africa, despite the fact that the un- conditional CSG has been in operation for over 10 years and conditionality has


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