was designed to allow for a phase-in of conditional cash transfers. PROGRESSA provides cash
grants, given to women, conditional on children attending school regularly and utilising preven-
tative health measures (health care visits, nutritional supplements and participation in health
education programmes). The programme was launched in 1998, but budgetary constraints
made it impossible to roll the programme out nationally. Hence, the Mexican authorities rolled
the programme out randomly, and used this phase-in design to help evaluate the pro ject.11
Schultz (2007) finds that enrollment increases by 3.4% for students in Grades 1-8, with the
increase being larger for girls. In addition, participants who received the transfers enjoyed
improved health outcomes. Gertler and Boyce (2001) demonstrate that the incidence of ill-
ness was reduced by 23% amongst recipient children, and the incidence of anemia was reduced
by 18%. Moreover, children experienced a 1-4% increase in height. Behrman and Hoddinott
(2000) demonstrate that for children aged 1-3 years, those who receive the treatment experience
higher growth rates and are significantly less likely to be stunted. They estimate that treat-
ment children experience an increase in growth rates of 16% of the mean growth rate relative
to those who do not receive the treatment, and that these effects are larger for children from
relatively poorer households. To the extent that health gains in early childhood translate into
better cognitive development and academic performance at school, better health status and
thus earnings potential as an adult, Berhman and Hoddinott (2000) estimate that exposure to
the PROGRESSA treatment will result in an increase of 2.9% in lifetime earnings.
Given the success of the PROGRESSA programme, similar conditional cash transfer pro-
grammes have been implemented elsewhere. PROGRESSA was replicated in Colombia, al-
though there the programme was called Familias en Accion (FA). In this programme, mothers
of children aged 0-17 were eligible to receive assistance. Beneficiary families with children under
the age of 5 are eligible to receive a cash subsidy for nutrition, but to qualify for this, moth-
ers must take their children for regular clinic visits. In addition, mothers are encouraged to
participate in local education sessions on health and hygiene, and contraception. Households
with children aged 6-17 receive a separate monthly grant per child, conditional on the child
attending at least 80% of their classes. Attanasio et al (2005) demonstrate that FA had large
and significant impacts on school attendance for children aged 12-17, increasing attendance by
10.1% in rural areas, and 5.2% in urban areas. The effect amongst children aged 8-11 was
negligible, and they argue that this is mainly due to the fact that attendance amongst this
cohort was high even prior to the introduction of the programme. FA also increased household
consumption (and thus household welfare) significantly by 19.5% in rural areas, and by 9.3%
in urban areas, with the bulk of this increased expenditure being devoted to food and clothing
and footwear for children. Since FA requires children to visit clinics regularly, it is perhaps
unsurprising to find that this significantly increased the number of children aged 0-2 who had
an up-to-date schedule of health care visits, from 17% to 40%. Amongst children aged 2-4
years, this figure increased from 33.6% to 66.8%. FA also reduced the incidence of diarrhoea
by approximately 10% for children aged 0-4 in rural areas.
In short, the evidence suggests that nutritional supplementation has significant and positive
impacts on child development outcomes, and may yield added benefits in the form of higher
school attendance, better academic performance and lower dropout rates.
7.1.2 Iron supplementation
Walker et al (2007) estimate that 44-66% of all children aged 4 and below in developing countries
suffer anemia, with half of these cases being attributable to iron deficiencies. Iron deficiency
holds negative consequences for child outcomes. From a survey of 21 articles, 19 report that
young children with iron deficiency anemia have lower mental, social-emotional, motor and brain
functioning than infants without (Lozoff et al, 2006; Grantham-McGregor, 2001). Importantly
though, iron treatment in pre-school aged children with iron deficiency anemia has yielded
11 While conditional cash transfer programmes have become increasingly popular as vehicles of development,
their success does require that the conditionality be enforced. This involves an additional level of monitoring
and an evaluation of the process.
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