Conditional Cash Transfer Program

Conditional cash transfer (CCT) programs aim to reduce poverty by making welfare
programs conditional upon the receivers' actions. The government (or a charity) only transfers the
money to persons who meet certain criteria. These criteria may include enrolling children into public
schools, getting regular check-ups at the doctor's office, receiving vaccinations, or the like. CCTs are
unique in seeking to help the current generation in poverty, as well as breaking the cycle of poverty for
the next through the development of human capital.
Conditional Cash Transfer (CCT) programs are now found in more than 20 developing countries.
World Health Organization is to lend 2.4 Billion US dollars to start or expand CCTs in countries
around the globe.
In the Philippines, the Aquino administration plans to increase the budget for the program from P34
billion this year to around P45 billion in 2013. In 2011, the program has a P21.9 billion budget, almost
double than the P12 billion allotted in 2010.

CCT programs

have the following characteristics.

They are targeted to poor households
Cash transfers are usually paid to mothers.
Cash transfers may be made as a lump-sum or may vary depending on the number,
age and sex of children
Recipients commit to undertaking certain actions, such as enrolling children in school
or attending pre- and postnatal health care appointments
Some programs require women to attend regular health and nutrition training
workshops.
Some provide resources that improve the supply and quality of the schools and health
care facilities used by beneficiaries.

CCT programs aim to reduce current poverty while improving human capital formation and, thus
reduce the intergenerational transmission of poverty.
In Mexico, PROGRESA reduced: Poverty by 8.2%, the poverty gap by 23.6%, and the severity of
poverty by 34.5%.
IMPACT:
Impact on use of health-care services
Five studies, whose quality of evidence was judged to be low by the authors, had reported this
outcome. In one study involving people who had been tested for HIV, a greater proportion of (27
percentage points) of people in the intervention group (those who had received CCTs) returned to
the clinic for their results compared with controls (those who did not receive CCTs). Another study
found that where CCTs were offered to the population, there was an increase of 2.09% in the
number of daily outpatient visits to health-care facilities. A third study reported that use of healthcare services increased significantly for pre-school children, but there was no significant increase in
the uptake of antenatal care or 10-day postnatal check-ups. Another study reported increases in
the use of health-care services by 19.5 percentage points at 1 year and 11 percentage points at 2
years in the proportion of infants (up to 3 months old) brought to health-care centres.
Impact on health outcomes

Three studies of moderate quality were available for this outcome. The data showed that CCT
programmes could impact childrens health positively, but the effect was not consistent across all
age groups.

Impact on immunization coverage

Four studies of moderate quality reported the effects of CCTs on immunization coverage. One
reported mixed results for immunization coverage. The second showed an increase in relative
treatment effect of 6.9 (confidence interval 112.8) in coverage for the first dose DTP/pentavalent
vaccine among children. However, an increase was neither found for tetanus immunization in
pregnant women nor for measles vaccination among children. A study of a CCT programme found
an increase in the probability that 24-month-old children would comply with DPT vaccination
schedule (relative treatment effect 8.9; standard error 0.047). Another study found no significant
impact on vaccination coverage.

Impact on anthropometric or nutritional outcomes

Six papers of moderate quality reported outcomes on anthropometric measures and nutritional
status from four different CCT programmes. A study from Colombia showed mixed results regarding
the impact of CCTs on the nutritional status of children: there was a positive impact on nutritional
status for children under age 24 months and an increase of 0.58 kg in newborn weight in urban
areas in the study, but this effect was not seen in rural areas. In Nicaragua, the study found a
reduction in the magnitude of stunting and proportion of under-weight children aged 05 years, but
no impact was found on the proportion of wasted children aged 05 years. An evaluation of a
Brazilian CCT programme showed no effect on height-for-age measures and even a negative impact
on weight-for-age for children under 7 years old.
Finally, three studies reported findings for a Mexican CCT programme. One found a significant
impact on growth for the youngest children (< 6 months old) in the poorest households, but no
difference for older children (aged 612 months) or for the youngest children from less poor
families. Another study reported a similar result on height gain. A third study found a positive effect
on the height of children aged 1236 months.
Others:

In Mexico, health visits increased by 18 percent in PROGRESA localities, and illnesses among
children 05 years old were reduced by 12 percent.
Young children in Honduras increased their use of health services by 1521 percentage points
Stunting was reduced in Nicaragua by 5.5 points, and in Colombia by 7 points.
In both Mexico and Nicaragua, calorie intake increased, as did the consumption of fruits,
vegetables, meat, and dairy products.

Conditional cash transfers exist in the following countries, among many others:

Brazil: Bolsa Famlia (formerly Bolsa Escola) started in the 1990s and expanded rapidly in
2001 and 2002. It provides monthly cash payments to poor households if their school-aged
children (between the ages of 6 and 15) are enrolled in school, and if their younger children (under
age 6) have received vaccinations.[1][2]

Chile: Chile Solidario, established in 2002,[3] requires the family to sign a contract to meet 53
specified minimum conditions seen as necessary to overcome extreme poverty. In exchange, they
receive from the state psychosocial support, protection bonds, guaranteed cash subsidies, and
preferential access to skill development, work and social security programmes. [4]

Colombia: Familias en Accin,[3] established in 2002, is a conditional cash transfer

programme, very similar to the Mexican PROGRESA/Oportunidades, consisting of cash transfers to
poor families conditional on children attending school and meeting basic preventive health care
requirements.[5]

Honduras: The Family Allowance Program (PRAF II) created in 1998 was based on the PRAF I
program created in 1990.[6] The Family Allowance Program, PRAF, founded in 1990 as a social
compensation program of the government of the Republic of Honduras. [7][8]

Jamaica: Programme of Advancement Through Health and Education (PATH), administered by

the Ministry of Labour and Social Security, [3] is a conditional cash transfer (CCT) programme. It
provides cash transfers to poor families, who are subject to comply with conditions that promote
the development of the human capital of their members. PATH was created in 2001, as part of a
wide-ranging reform of the welfare system carried out by the government of Jamaica. [9]

Indonesia: Program Keluarga Harapan and Program Nasional Pemberdayaan MasyarakatGenerasi Sehat dan Cerdas, both established in 2007. The Program Keluarga Harapan is a
household CCT program, while Program Nasional Pemberdayaan Masyarakat is a community-based
CCT program. They are focused on reducing poverty, maternal mortality, and child mortality and
providing universal coverage of basic education. [10]

Mexico: Oportunidades is the principal anti-poverty program of the Mexican government. (The
original name of the program was Progresa; it was changed in 2002.) Oportunidades focuses on
helping poor families in rural and urban communities invest in human capitalimproving the
education, health, and nutrition of their children The Progresa program was one of the first largescale conditional cash transfer programs.

Guatemala: Mi Familia Progresa, established April 16, 2008, is a conditional cash transfer
program that is intended to provide financial support to families living in poverty and extreme
poverty and who have children age 0 to 15 years and/or pregnant women or nursing mothers who
live mainly in rural and marginal areas of the peripheries of urban centers (cities).

Nicaragua: The Social Protection Network, established in 2000 and implemented by the Social
Emergency Fund (FISE), was terminated in 2005.

Panama: Red de Oportunidades is a program implemented by the Government of Panama to

the population under 18 to provide them access to health services and education.

Philippines: Department of Social Welfare and Development Pantawid Pamilyang Pilipino

Program, is a social development strategy of the national government that provides conditional
cash grants to extremely poor households to improve their health, nutrition and education
particularly of children age 0-14.

Peru: Juntos was established in 2005. The program provides a monthly dividend to mothers
(married or single) living in extreme poverty. Mothers can only qualify for the program if they send
their children to school and take them for regular medical checkups.

Turkey: artl Nakit Transferi (N), established in 2003 and it is still being implemented by the
General Directorate of Social Assistance (GDSA: Sosyal Yardmlar Genel Mdrl).

Egypt: Program Minhet El-Osra, began in 2009, currently being piloted in an urban slum in
Cairo, Ain Es-Sira, and 65 villages in rural Upper Egypt by the Egyptian Ministry of Social Solidarity

United States of America: Opportunity NYC. ONYC ended on August 31, 2010. The program
built on the conceptual framework and success of international conditional cash transfer (CCT)
programs and was the first major CCT initiative implemented in the United States. The principal
objective of Opportunity NYC Family Rewards was to test the impact of monetary incentives on
childrens education, family health and adults workforce outcomes.

Bangladesh: Female Secondary School Assistance Project, established in 1994. This CCT
program, conditional only on school attendance and girls remaining unmarried, provides tuition
and stipends.

Cambodia: Cambodia Education Sector Support Project, established in 2005, is conditional on

attendance and maintaining passing grades.

Urban Health System Development (UHSD) Program

I.

RATIONALE

In developing countries, the rapid rate of urbanization has outpaced the ability of governments to build essential
infrastructure for health and social services. Among many features of urbanization in developing countries include
greater population densities and more congestion, concentrated poverty and slum formation, and greater exposure
to risks, hazards and vulnerabilities to health (eg. violence, traffic injuries, obesity, and settlement in unsafe areas).
The concentration of risks is seen in the poorest neighborhoods resulting to health inequities.
From the above, it will require more than the provision and use of health services to improve the health of urban
populations. UHSD must help cities address the challenges of rapid urbanization brought about by the interplay of
different social determinants of health.
II.

UHSD GOALS AND OBJECTIVES

A.

Goals

1.

To improve Health System Outcomes

Urban Health Systems shall be directed towards achieving the following

goals: (i) Better Health Outcomes; (ii) More equitable healthcare financing; and (iii) Improved responsiveness and
client satisfaction.
2.

To influence social determinants of health

The DOH must help influence social determinants of health in

urban settings, with focused application on urban poor populations particularly those living in slums.
3.

To reduce health inequities

Urban Health Systems Development seeks to narrow the disparity of health

outcome indicators between the rich and the poor.

B.

General objective: To address the Urban Health challenge

C.

Specific objectives:

1.

To establish awareness on the challenges of Urban Health;

2.

To initiate inter-sectoral approach to Urban Health Systems Development; and

3.

To guide LGUs to develop sustainable responses to the Urban Health challenge

III.

Components

The following are the developmental components of the UHSD Program:

1.
-

Programs and Strategies

Healthy Cities Initiative (HCI): the approach of continuously improving health and social determinants of health,

and continually creating and improving physical and social environments shall be continued and further
strengthened.
-

Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a strategy of going to every

depressed barangay to reach the urban poor, vulnerable groups and hidden slums to increase access to health
services.
-

Environmentally Sustainable and Healthy Urban Transport (ESHUT) initiatives which include the development or

enhancement of existing projects that improve the policy, design and practice of an urban transport system and
lead to improvement of health and safety of urban population.
2.
-

Planning Tools and Framework

Urban Health Equity Assessment and Response Tool (Urban HEART): a tool to facilitate identification of and

response to health equity concerns. It is used as a situational assessment, monitoring and planning tool particularly
for Highly Urbanized Cities, in tandem with the Local Government Unit (LGU) Scorecard.
-

City-wide Investment Planning for Health (CIPH): a framework for the development of public investment plans in

health covering the utilization, mobilization and rationalization of the citys relatively abundant resources, more
extensive capabilities and stronger institutions to attain health system goals.
3.

Capability Building

Short Course on Urban Health Equity (SCUHE) is a 6-month course offered to cities and urban stakeholders that
aims to improve the knowledge, practice and skills of health practitioners, policy and decision-makers at the
national, regional and city levels to identify and address urban health inequities and challenges, particularly in
relation to social determinants of health.
IV.
1.

General Principles
Healthy urbanization. Urban Health Systems (UHS) must promote healthy urbanization so that cities develop in

ways that achieve better health and avoid risks to ill health under conditions of rapid urbanization.
2.

Inter-sectoral action. UHS must be designed through inter-sectoral collaboration with people and institutions

from outside the health sector to influence a broad range of health determinants and generate responses producing
sustainable health outcomes.
3.

Inter-city coordination. Inter-city coordination between contiguous cities is important because a city,

particularly if it is not a Highly Urbanized City may not have all the resources, institutions and capacities to be able
to respond to the entire health needs of its constituents, and may thus benefit from resources, institutions and
capacities of other cities through inter-city or inter-LGU coordination.
4.

Social cohesion. Social cohesion is action through core groups.

5.

Community participation. Community participation must be integrated in all aspects of the intervention

process, including planning, designing, implementing, and sustaining any project/program.

6.

Empowerment. Empowerment is enabling individuals and communities to have ultimate control over key

decisions involving their wellbeing through strategies such as building knowledge and purchasing power, and
mechanisms to increase client accountability.
The DOH approach in the reform of urban health systems is the management of social determinants of health in
urban settings, with focused application on poor populations, particularly those living in slum

communities/settlements to address equity concerns.

Briefer on the Urban Health Equity Assessment and Response Tool (Urban HEART)
I.

Rationale:

Rapid unplanned urbanization gives rise to urban poverty, health problems, and health inequities in the cities.
Disparities in health system outcomes between the affluent and the poor are becoming more prominent in highly
urbanized areas as government sectors find it hard to cope with the increasing demands of the fast growing
population of urban poor.
To address the above concerns, the Urban HEART or the Urban Health Equity Assessment and Response Tool was
developed by the WHO Centre for Health Development in Kobe, Japan to assist Ministries of Health of countries in
systematically generating evidence to assess and respond to unfair health conditions and inequity in the urban
setting. It was initially launched in Tehran, Iran on April 2008, and the Philippines along with Iran, Zambia, and Brazil
were the pilot sites to test the Urban HEART in each country.
Seven cities initiated the use of the Urban HEART in the Philippines in 2008-2009, namely: Paranaque City, Taguig
City, Olongapo City, Naga City, Tacloban City, Zamboanga City, and Davao City. The cities helped develop the tool
for applicability in varied urban settings in the country.
Urban Health Systems need to establish evidence on the status of the disadvantaged population in the highly
urbanized areas in order to develop objective interventions to address inequities. Department Memorandum No.
2010-0207 dated August 20, 2010 on the Use of the Urban Health Equity Assessment and Response Tool in Highly
Urbanized Cities is intended to help Highly Urbanized Cities (HUCs) generate systematic data on health inequities
to guide effective interventions.