Oxbridge Notes | Conditional Cash Transfers Health

CONDITIONAL CASH TRANSFERS & HEALTH

WHAT ARE ‘CONDITIONAL CASH TRANFER’ PROGRAMS?

Conditional cash transfers (CCT) are one of the most prevalent poverty reduction programs in low and middle-income countries – ‘In Latin America and the Caribbean, for instance, there are currently 26 CCT programs in operation, benefitting over 135 million people’. [Saavedra]
CCTs are delivered on the condition that beneficiary households meet certain criteria, such as enrolling children in public schools, receiving vaccinations, attending health education sessions, etc.

‘These programs target both current poverty through income transfers and future poverty by encouraging investments in human capital’ [UN]

A key feature of CCTs is its use of explicit targeting strategies to determine eligibility for benefits – ‘Poor localities are identified using a wellbeing index constructed on census/survey information, program localities are selected randomly up to a budget constraint and all households within the selected localities are eligible for enrollment’. [Gaarder et. al]

UNDERLYING ASSUMPTIONS [Gaarder et. al]	CRITIQUE
Sub-optimal utilization of existing preventive health services by the poor	Calculating of private and social ‘optimums’ would require entering into a delicate discussion of the relative statistical value of healthy versus disability-adjusted life and allocating budgets in accordance with such judgements.
Increased provision and (subsequent) utilization of public health services will improve health status	Insofar as sub-utilization relates to inadequate quality or distribution/inaccessibility (unaffordable transportation costs), increased provision of public health services is counter-intuitive and improvident. Household resource scarcity implies that the poorest households must reach a minimum threshold of food consumption before they are able to further invest in their wellbeing* Underestimates causal link between higher real wages and poverty reduction. According to the Economic Policy Institute, ‘broad-based wage growth would dwarf the impact of nearly every other economic trend or policy in reducing poverty’. CCTs are predicated on state interests which are affected by the longevity/whims of the current government. This creates an artificial, residual understanding of affliction as purely caused by the denial of access to formal health provisioning. However, O’Laughlin argues that ‘contemporary forms of affliction cannot be understood without locating them within characteristic, enduring and historically specific ways of organizing capitalist production.’ For example, the resurgence of malaria in Swaziland was linked to: The development of sugar estates – stagnant water pools in the irrigation system, combined with poor housing and sanitary conditions for workers, provided a fertile breeding ground for mosquitoes. Movement of infected populations in search of jobs Increased refugee flows during the Mozambican civil war The administrative weakness of malaria control programs ‘If we allow the politics of health to do no more than follow the shifting effects of structural contradictions in the labor-reserve system – If we restrict ourselves to treating those who are already ill, or to find palliative ways of living with affliction – then we do no more than accept the boundaries of suffering’ [O’Laughlin]
Insufficient income is not the only contributing factor to inadequate health investments; poor women lack sufficient health knowledge and thus would benefit from a transfer of information to induce behavior change.	‘The specification of women in beneficiary households assumes that women alone are responsible for ensuring/supervising the health-seeking activities of their children, and that they prioritize child health...

Sub-optimal utilization of existing preventive health services by the poor

Calculating of private and social ‘optimums’ would require entering into a delicate discussion of the relative statistical value of healthy versus disability-adjusted life and allocating budgets in accordance with such judgements.

Increased provision and (subsequent) utilization of public health services will improve health status

Insofar as sub-utilization relates to inadequate quality or distribution/inaccessibility (unaffordable transportation costs), increased provision of public health services is counter-intuitive and improvident.
Household resource scarcity implies that the poorest households must reach a minimum threshold of food consumption before they are able to further invest in their wellbeing*

Underestimates causal link between higher real wages and poverty reduction. According to the Economic Policy Institute, ‘broad-based wage growth would dwarf the impact of nearly every other economic trend or policy in reducing poverty’.

CCTs are predicated on state interests which are affected by the longevity/whims of the current government. This creates an artificial, residual understanding of affliction as purely caused by the denial of access to formal health provisioning. However, O’Laughlin argues that ‘contemporary forms of affliction cannot be understood without locating them within characteristic, enduring and historically specific ways of organizing capitalist production.’

For example, the resurgence of malaria in Swaziland was linked to:

The development of sugar estates – stagnant water pools in the irrigation system, combined with poor housing and sanitary conditions for workers, provided a fertile breeding ground for mosquitoes.
Movement of infected populations in search of jobs
Increased refugee flows during the Mozambican civil war
The administrative weakness of malaria control programs

‘If we allow the politics of health to do no more than follow the shifting effects of structural contradictions in the labor-reserve system – If we restrict ourselves to treating those who are already ill, or to find palliative ways of living with affliction – then we do no more than accept the boundaries of suffering’ [O’Laughlin]

Insufficient income is not the only contributing factor to inadequate health investments; poor women lack sufficient health knowledge and thus would benefit from a transfer of information to induce behavior change.

‘The specification of women in beneficiary households assumes that women alone are responsible for ensuring/supervising the health-seeking activities of their children, and that they prioritize child health...

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