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Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets

Authors: Thomas M. Crea, Andrew D. Reynolds, Aakanksha Sinha, Jeffrey W. Eaton, Laura A. Robertson, Phyllis Mushati, Lovemore Dumba, Gideon Mavise, J. C. Makoni, Christina M. Schumacher, Constance A. Nyamukapa, Simon Gregson

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets.

Methods

Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.

Results

Orphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.

Conclusion

Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection which are not moderated by other child- and household-level risk factors, but orphans are less likely to attend school or obtain birth registration. The effects of UCT and CCT are not moderated by asset-holding, but greater household assets predict greater social protection outcomes. Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children. These efforts might include caregiver education, and additional incentives based on efforts made specifically for orphaned children.
Footnotes
1
Double-unknown parent status was not estimated in the disability model as there was no variation in the dependent variable (i.e., no double-unknown orphan status children had a disability).
 
Literature
1.
Fiszbein A, Schady N. Conditional cash transfers: reducing present and future poverty. Washington, DC: World Bank; 2009.CrossRef
2.
Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379:1320–9.CrossRefPubMed
3.
Robertson L, Mushati P, Eaton JW, Dumba L, Mavise G, Makoni J, et al. Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomized trial. Lancet. 2013;381:1283–92.CrossRefPubMedPubMedCentral
4.
Zaba B, Calvert C, Marston M, Isingo R, Nakiyinga-Miiro J, Lutalo T, et al. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for analysing longitudinal population-based HIV/AIDS data on Africa (ALPHA). Lancet. 2013;381:1763–71.CrossRefPubMedPubMedCentral
5.
UNICEF. A situational analysis on the status of women’s and children’s rights in Zimbabwe, 2005–2010: a call for reducing disparities and improving equity. Zimbabwe, Harare: UNICEF; 2011.
6.
Bryant JH. Kenya's cash transfer programme: protecting the health and human rights of orphans and vulnerable children. Health Hum Rights. 2009;11(2):65–76.PubMed
7.
Luseno WK, Singh K, Handa S, Suchindran C. A multilevel analysis of the effect of Malawi’s social cash transfer pilot scheme on school-age children’s health. Health Policy Plan. 2013. doi:10.1093/heapol/czt028.PubMedPubMedCentral
8.
Baird S, McIntosh C, Ozler B. Cash or condition? evidence from a cash transfer experiment. Q J Econ. 2011;126(4):1709–53.CrossRef
9.
10.
Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries. J Am Med Assoc. 2007;298(16):1900–10.CrossRef
11.
12.
Lerman R, McKernan SM. The effects of holding assets on social and economic outcomes of families: a review of theory and evidence. Washington, DC: The Urban Institute; 2008.
13.
Schenck KD, Michaelis A, Sapiano TN, Brown L, Weiss E. Improving the lives of vulnerable children: implications of horizons research among orphans and other children affected by AIDS. Public Health Rep. 2010;125:325–36.
14.
Foster GR, Shakespeare F, Chinemana H, Jackson S, Gregson S, Marange C, et al. Orphan prevalence and extended family care in a peri-urban community in Zimbabwe. AIDS Care. 1995;7(1):3–17.CrossRefPubMed
15.
Ciganda D, Gagnon A, Tenkorang EY. Child and young adult-headed households in the context of the AIDS epidemic in Zimbabwe, 1988–2006. AIDS Care: Psycho and Soc Aspects of AIDS/HIV. 2012;24(10):1211–8.CrossRef
16.
UNICEF. Social protection in eastern and southern Africa: a framework and strategy for UNICEF. Nairobi, Kenya: UNICEF; 2008.
17.
Ssewamala FM, Han CK, Neilands TB, Ismayilova L, Sperber E. Effect of economic assets on sexual risk-taking intentions among orphaned adolescents in Uganda. Am J Public Health. 2010;100(3):483–8.CrossRefPubMedPubMedCentral
18.
Crea TM, Lombe M, Robertson LA, Dumba L, Mushati P, Makoni JC, et al. Asset ownership among households caring for orphans and vulnerable children in rural Zimbabwe: the influence of ownership on children’s health and social vulnerability. AIDS Care: Psycho and Soc Aspects of AIDS/HIV. 2013;25(1):126–32.CrossRef
19.
Adato M, Bassett L. What is the potential of cash transfers to strengthen families affected by HIV and AIDS? a review of the evidence on impacts and key policy debates. Washington, DC: Joint Learning Initiative on Children and AIDS, International Food Policy Research Institute; 2008.
20.
Goudge J, Russell S, Gilson L, Gumede T, Tollman S, Mills A. Illness-related impoverishment in rural south Africa: Why does social protection work for some households but not others? J Int Dev. 2009;21:231–51.CrossRef
21.
Miller C, Tsoka M, Reichert K. Impact evaluation report: external evaluation of the mchinji social cash transfer pilot. Boston, MA: Center for International Health and Development, School of Public Health, Boston University; 2008.
22.
Filmer D, Pritchett L. The effect of household wealth on education attainment: evidence from 35 countries. Popul Dev Rev. 1999;25(1):85–120.CrossRef
23.
Chowa GAN, Ansong D, Masa R. Assets and child well-being in developing countries, A research review. CSD working paper No. 09–38. St. Louis, MO: Center for Social Development, George Warren Brown School of Social Work, Washington University in St. Louis; 2009.
24.
Hazarika G, Sarangi S. Household access to microcredit and child work in rural Malawi. World Dev. 2008;36(5):843–59.CrossRef
25.
Fernald, L. C. H. (2013). Promise, and risks, of conditional cash transfer programmes. Lancet, 382, doi:10.1016/S0140-6736(13)61035-1
26.
Fernald LCH, Gertler P, Neufeld LM. Role of cash in conditional cash transfer programmes for child health, and development: an analysis of Mexico’s oportunidades. Lancet. 2008;371:828–37.CrossRefPubMedPubMedCentral
27.
Ranganathan M, Lagarde M. Promoting healthy behaviors and improving health outcomes in low and middle-income countries: a review of the impact of conditional cash transfer programmes. Preventive Med. 2012;55 Suppl 1:S95–S105.CrossRef
28.
Rasella D, Aquino R, Santos CAT, Paes-Sousa R, Barreto ML. Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet. 2013;382:57–64.CrossRefPubMed
29.
Robertson L, Mushati P, Eaton J, Sherr L, Makoni JC, Skovdal M, et al. Cash transfer targeting strategies in Zimbabwe: Are we reaching the most vulnerable children? Soc Sci Med. 2012;75:2503–8.CrossRefPubMedPubMedCentral
30.
31.
Alderman H, Behrman J, Watkins S, Kohler H-P, Maluccio JA. Attrition in longitudinal household survey data. Demogr Res. 2001;5:79–124.CrossRef
32.
Falaris EM. The effect of survey attrition in longitudinal surveys: evidence from Peru, Côte d’Ivoire and Vietnam. J Dev Econ. 2003;70(1):133–57.CrossRef
33.
Lopman B, Lewis J, Nyamukapa C, Mushati P, Chandiwana S, Gregson S. HIV incidence and poverty in manicaland, Zimbabwe: is HIV becoming a disease of the poor? AIDS. 2007;21(Suppl7):S57–66.CrossRefPubMedPubMedCentral
34.
Raudenbush S, Bryk A. Hierarchical linear models (2nd ed., p. 485). Thousand Oaks, CA: Sage Publications, Inc; 2002.
35.
Skinner D, Tsheko N, Mtero-Munyati S, Segwabe M, Chibatamoto P, Mfecane S, et al. Towards a definition of orphaned and vulnerable children. AIDS & Behavior. 2006;10:619–26.CrossRef
36.
Nyamukapa C, Gregson S. Extended family’s and women’s roles in safeguarding orphans’ education in AIDS-afflicted rural Zimbabwe. Soc Sci Med. 2005;60(10):2155–67.CrossRefPubMed
37.
Sherr L, Varrall R, Mueller J, Richter L, Wakhewya A, Adato M. A systematic review on the meaning of the concept ‘AIDS Orphan’: confusion over definitions and implications for care. AIDS Care. 2008;20(5):527–36.CrossRefPubMed
38.
Whetten, K., Ostermann, J., Whetten, R. A., Pence, B. W., O’Donnell, K., Messer, L. C., Thielman, N. M., The Positive Outcomes for Orphans (POFO) Research Team. (2009). A comparison of the wellbeing of orphans and abandoned children ages 6–12 in institutional and community-based care settings in 5 less wealthy nations. PLoS One, 4(12), doi:10.1371/journal.pone.0008169
39.
De Bruin-Cardozo I, Mumbani R. Strategic analysis in civil registration in the context of HIV and AIDS, President’s emergency plan for AIDS relief (PEPFAR), plan international, united nations Children’s fund (UNICEF). World Vision. Pretoria, RSA: Centre for the Study of AIDS, University of Pretoria; 2008.
40.
Metadata
Title
Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets
Authors
Thomas M. Crea
Andrew D. Reynolds
Aakanksha Sinha
Jeffrey W. Eaton
Laura A. Robertson
Phyllis Mushati
Lovemore Dumba
Gideon Mavise
J. C. Makoni
Christina M. Schumacher
Constance A. Nyamukapa
Simon Gregson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1857-4

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