Forde, I; (2012) Impacts of a conditional cash transfer scheme on health in Colombia. Doctoral thesis , UCL (University College London).

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Abstract

Conditional cash transfer schemes (CCTS) are increasingly popular interventions aiming to improve the welfare of the worst off: Families receive regular cash as long as they comply with behavioral conditions concerning uptake of preventive healthcare and schooling. Literature Review, however, finds that associated health impacts are often small or inconsistent and are occasionally adverse. The aim of this thesis is to advance understanding of the impact of CCTS on health and on health equity. It does this by examining the effect of Familias, the Colombian scheme, on outcomes little discussed in the literature, namely rates of obesity in women and in children (an unintended outcome), and women’s healthcare knowledge. It sets findings within a conceptual framework that sees health as being co-produced between individuals and society. Co-production requires investment in individuals’ human capital, material resources and creation of fairer socioeconomic environments, somewhat resembling the underpinning philosophy and structure of CCTS. Multiple regression on a range of individual, household and community level covariates using an intention-to-treat protocol on prospectively collected data with matched controls finds that Familias is associated with increased odds of obesity in women (O.R.=1.41, 95% C.I. 1.09, 1.82; p=0.01) and odds of overweight or obesity in girls aged 2-7 at baseline (O.R.=2.13, 95% C.I. 1.23, 3.69; p<0.01). Furthermore, Familias fails to improve healthcare knowledge, a marker of human capital, in women despite being a core objective of the programme (logit coefficient= -0.20, 95% C.I. -0.41, 0.01; p=0.06). Given these negative findings, a number of policy recommendations are made emphasising the importance of social determinants of health: balancing imposition of behavioural requirements with the realisation of rights to high-quality public services, considering the potential for universalising aspects of the schemes and exploring a greater role for the health sector in CCTS design, operation and evaluation.

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