Long-term follow-up of children enrolled in Mexico's conditional cash transfer (CCT) programme 'Oportunidades' has shown a range of benefits for child health and development. Furthermore, an additional 18 months of inclusion in the Oportunidades programme in very early childhood reduced the number of socioemotional problems reported in children aged 8-10 years. The findings are reported in an Article Online First and in upcoming edition of the Lancet, written by Professor Lia Fernald, School of Public Health, University of California, Berkeley, CA, USA, and colleagues.
Mexico's Oportunidades (previously Progresa) was one of the first CCT programmes to be designed, and was started to improve the lives of poor families through interventions in health, nutrition, and education. The programme improved child growth after 2-5 years of enrolment in rural, and urban areas, and effects were strongest in vulnerable subgroups. In this study, the authors investigated the effect of Oportunidades on children almost 10 years after the programme began.
From April, 1997, to October, 1998, low-income communities were randomly assigned to be enrolled in Oportunidades immediately (early treatment, n=320) or 18 months later (late treatment, n=186). In 2007, when 1093 children receiving early treatment and 700 late treatment in these communities were aged 8-10 years, they were assessed for outcomes including physical growth, cognitive and language development, and socioemotional development. The primary objective was to investigate outcomes associated with the additional 18 months in the programme. The effects of programme participation on height-for-age, body-mass index (BMI), and cognitive and language and behavioural assessment scores were compared in early versus late treatment groups.
Early enrolment reduced behavioural problems for all children in the early versus late treatment group but there were no differences between groups for mean height-for-age BMI-for-age, assessment scores for language, or cognition. An additional 18 months of the programme before age 3 years resulted in improved child growth for children aged 8-10 years whose mothers had no formal education, of about 1·5 cm assessed as height-for-weight Z score, independently of cash received.
Furthermore, the authors say: "Our results show a significant, independent, positive association between cumulative cash transfers and height, cognition, and vocabulary score, and a negative association with behavioural problems, agreeing with the results we reported for these children when they were aged 3-5 years."
They conclude: "An inability to decipher the causal pathways by which CCTs have affected child outcomes is a key research gap. Our analysis takes advantage of the detailed information available for the Oportunidades programme in Mexico and the quality of cash transfer data to explore potential mechanisms for the effects of CCTs, recognising the limitations that this approach has for causal inferences. Together, these results suggest that independent beneficial effects of programme components exist in Oportunidades other than money—especially for women with no formal education—and that the money itself also has significant effects, adding to existing evidence for interventions in early childhood."
In an accompanying Comment, Santiago Cueto, GRADE (Grupo de Anàlasis para el Desarrollo), Lima, Peru, says: "From the policy perspective, why the provision of services for poor people seems to be still low in many developing countries should be clarified. There are many reasons, such as the higher costs per person of reaching poor populations with high-quality services (because they often live in isolated areas) and the limited political power and voice of these groups (compared with wealthy populations). However, accumulated global evidence from research on several conditional cash transfer programmes suggests that they need to be a part of combined interventions to fight poverty rather than isolated programmes that could overcome inequality on their own."
Journal
The Lancet