David Evans World Bank Joint work with Brian Holtemeyer and Katrina Kosec (IFPRI) July 9, 2015

Cash transfers have expanded dramatically around the world!

Source: Fiszbein et al 2009

Source: Garcia & Moore 2012 Countries in which CT programs have been implemented (35) Countries in which CT programs have been discussed, planned, or implemented (39)

… and so has evidence surrounding their impacts!

Source: Andrews et al (forthcoming)

Operational experience and contextual expertise International expertise on cash transfers and on impact evaluation Initial funding for the program & evaluation

≈ ≈

per child ( US $3) per month per adult ( US $6) per month on average

EducationHealth Children (age 0-5)Visit clinic 6x per year Children (age 7-15)Be enrolled with 80% attendance ElderlyVisit clinic 1x per year

 Identification of the poor…by communities  Distribution of payments…by communities  Monitoring of conditions…by communities

 Initial (after 18 mos.) positive impacts on health clinic visits disappeared by 2.5 years  Health benefits take 2.5 years to materialize (not present at 18 mos.), and are mostly driven by young children aged 0‐5 (not elderly)  Large increase in use of health insurance  Shift toward using publicly‐provided healthcare  Initial (after 18 mos.) increase in satisfaction with healthcare disappeared by 2.5 years (habituation)  No increase in objective healthcare quality

3 provinces selected to pilot Initial TreatmentInitial Comparison 80 eligible villages but only cash for 40 Treatment 2 years later with additional funding randomization

Randomizing led to balance on observable characteristics

Baseline survey (2009) Roll-out of payments (2010) Follow-up survey #1 (2011) Focus groups #1 (2011) Follow-up survey #2 (2012) Focus groups #2 (2013)

Time Outcome BaselineEndline Roll out program Treatment Comparison Diff at baseline Diff at endline Difference at endline - Difference at baseline Impact of program

 Carried out a principal components analysis (PCA) using dummy variables for ownership of 13 HH assets  Took the first principal component as our index of HH wealth  Households with above-median wealth: “moderately poor”  Households with below-median wealth: “extremely poor”

Private

 Use three methods to correct  Median significant results after correction Outcome area# significant results (90%) # significant results (corrected) Health clinic visits55 Illness or injury83 Health insurance66 Type of health provider146 Satisfaction22

 Conditional cash transfers effectively increase health for children  Initial increase in clinic visits (conditions)  Major increase in health insurance take-up (not conditioned)  Beware of satisfaction measures: Effects may disappear