Conditional Cash Transfers and Nutrition: An Evaluation of the Bolsa Familia Program in rural and urban areas of Brazil

Neto, Valdemar Rodrigues de Pinho; Berriel, Cecilia Machado

doi:10.11606/1413-8050/ea139199

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Still, studies using more comprehensive indicators of calorie quality find positive BF effects on nutrition (Coelho & Melo, 2017; Ferrario, 2014; Sperandio et al, 2017). Beneficiary children appear more likely to have normal height and weight (Paes‐Sousa et al, 2011), lower levels of anaemia (Cotta et al, 2011), less food insecurity (Menezes et al, 2017; Correia et al, 2018), decreased incidence of physical wasting (Neto & Berriel, 2017), and a lower prevalence of stunting (Oliveira et al, 2011) than non‐beneficiaries.…”

Section: Why Bolsa Família?mentioning

confidence: 99%

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

Csapo

2023

Development Policy Review

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Summary Motivation Cash transfers have become popular for relieving poverty in the Global South. Many programmes are conditional on beneficiaries complying with medical check‐ups, nutritional assessments, and vaccinations. Such conditions may improve the health of beneficiaries, above all the health of their young children. But often public health provision is strained. Might the increased attention to those getting the transfers reduce health services to non‐beneficiaries, and especially those on low incomes who cannot afford private medicine? Purpose What are the impacts of the largest and longest‐lived conditional cash transfer programme in the world, Brazil's Bolsa Família (BF), on the health of non‐beneficiaries living in poverty? Does the health of non‐beneficiaries suffer when BF requirements come into place? Do the health requirements of BF lead to increased administrative costs for local health centres? Do they squeeze remaining resources for health care? Methods and approach Surveys from before and after the creation of BF are used to model the probability of death for infants born into poor households, comparing those enrolled in BF to those not included. The impacts of the BF programme on local health budgets are modelled through regression analysis. The analysis takes advantage of the varying degree of coverage of BF at the level of municipalities across Brazil. Findings Implementation of BF led to lower risk of death of infants from beneficiary families than predicted by trends before BF, while infants from impoverished non‐beneficiary families developed a higher‐than‐expected risk of death. The benefits to the former group were larger than the harm to the latter group, which explains why BF appears to reduce infant and child mortality in aggregate. The expansion of BF depressed local spending on primary health care. Above all, more of the health budget and staff time was spent on monitoring compliance with health conditionalities. Policy implications The harmful spillovers from BF to the health of low‐income households who were not included in the programme pose questions about the conditions that often accompany cash transfer programmes. In cases like Brazil, where budgets for public health care are limited, unconditional transfers might be preferable. Or, if health conditions are applied to cash transfer beneficiaries, then extra resources need to be granted to health centres to allow them to deal with the increased demand from beneficiaries for services.

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Section: Why Bolsa Família?mentioning

confidence: 99%

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

Csapo

2023

Development Policy Review

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“…In light of the above, although studies point to the positive health outcomes of the PBF itself [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and of interventions related to environmental health [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], as well as to the effects of the PBF combined with other health policies and programs [27,[50][51][52][53], none have so far PLOS ONE evaluated the joint action of these two public policies in an interaction model, which is the objective of the current study.…”

Section: Introductionmentioning

confidence: 99%

Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006–2016

Souza¹,

Mingoti

Paes-Sousa³

et al. 2021

PLoS ONE

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Introduction Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far. Objective To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases. Methods Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities. Results Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases. Conclusion Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.

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Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities

et al. 2021

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Background This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old. Methods The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies. Results In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28–1.04) / 0.55 (0.29–1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95–1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97–1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96–1.00), 0.98 (0.97–1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95–0.98), 0.97 (0.95–0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991–1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002–1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002–1.0005), resulting in malnutrition mortality rates increase. Conclusion Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.

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Conditional Cash Transfers and Nutrition: An Evaluation of the Bolsa Familia Program in rural and urban areas of Brazil

Cited by 3 publications

References 12 publications

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006–2016

Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities

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