Correa Ossa, Ana; (2024) Health Externalities of Conditional Cash Transfers: Evidence from Colombia’s Familias en Acción. Doctoral thesis (Ph.D), UCL (University College London).

Text Ana Correa Ossa - Final Thesis.pdf - Other Access restricted to UCL open access staff until 1 July 2025. Download (8MB)

Abstract

Conditional cash transfers (CCTs) are social programmes that have been shown to improve health outcomes for beneficiaries. There has been limited research on the externalities of these programmes on non-beneficiaries. The aim of this thesis is to evaluate the presence and mechanisms of health externalities of Familias en Acción, a Colombian CCT programme. Following an evidence review of the externalities of CCT programmes, I develop a typology based on three mechanisms: local economy effects, public health effects, and peer effects. The first analytical chapter evaluates a potential externality of Familias en Acción, through a public health effects mechanism. I explore the impact of this programme on improvements to housing, and whether these have reduced the incidence of vector-borne diseases in the community. I find that as the beneficiary density increases, there is an increase in improved housing, leading to decreased incidence of malaria, diarrhoeal disease mortality, Chagas disease, and leishmaniasis. The second analytical chapter evaluates a potential externality of Familias en Acción, through a local economy effects mechanism. I explore the impact of this programme on healthcare investment requests by local providers. I find that, in anticipation of beneficiary density increases, there is an increase in the value and number of healthcare investment requests. The third analytical chapter explores a potential externality of Familias en Acción, through a peer effects mechanism. I evaluate the impact of this programme on teenage pregnancy rates. I find that as beneficiary density increases, there is a reduction in teenage pregnancy rates, particularly for girls aged 10-14 in urban contexts. In the final chapter, I discuss the policy and research implications of these results. There is scope for Familias en Acción to coordinate with housing and sanitation schemes, local health infrastructure planning, and adolescent sexual health programmes to amplify positive externalities or ameliorate negative ones. Finally, further research could make use of the typology of externality mechanisms I developed, to continue to explore externalities of CCT programmes, and design policy that can harness the mechanisms with the aim of improving population health.

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