Sarah Baird

Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial

BACKGROUND Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women. METHODS In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly payments ranging from US

The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women

1 to

Income shocks and adolescent mental health

5, while their parents were independently assigned with computer-generated random numbers to receive

Conditional, unconditional and everything in between: a systematic review of the effects of cash transfer programmes on schooling outcomes

4-10. Behavioural risk assessments were done at baseline and 12 months; serology was tested at 18 months. Participants were not masked to treatment status but counsellors doing the serologic testing were. The primary outcomes were prevalence of HIV and herpes simplex virus 2 (HSV-2) at 18 months and were assessed by intention-to-treat analyses. The trial is registered, number NCT01333826. FINDINGS 88 enumeration areas were assigned to receive the intervention and 88 as controls. For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data, weighted HIV prevalence at 18 month follow-up was 1·2% (seven of 490 participants) in the combined intervention group versus 3·0% (17 of 799 participants) in the control group (adjusted odds ratio [OR] 0·36, 95% CI 0·14-0·91); weighted HSV-2 prevalence was 0·7% (five of 488 participants) versus 3·0% (27 of 796 participants; adjusted OR 0·24, 0·09-0·65). In the intervention group, we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence (3/235 [1%] vs 4/255 [2%]) or weighted HSV-2 prevalence (4/233 [1%] vs 1/255 [<1%]). For individuals who had already dropped out of school at baseline, we detected no significant difference between intervention and control groups for weighted HIV prevalence (23/210 [10%] vs 17/207 [8%]) or weighted HSV-2 prevalence (17/211 [8%] vs 17/208 [8%]). INTERPRETATION Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies. FUNDING Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Banks Research Support Budget, and several World Bank trust funds (Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund).

Designing Cost-Effective Cash Transfer Programs to Boost Schooling Among Young Women in Sub-Saharan Africa

Recent evidence suggests that conditional cash transfer (CCT) programs for schooling are effective in raising school enrollment and attendance. However, there is also reason to believe that such programs can affect other outcomes, such as the sexual behavior of their young beneficiaries. Zomba Cash Transfer Program is a randomized ongoing CCT intervention targeting young women in Malawi that provides incentives (in the form of school fees and cash transfers) to current schoolgirls and recent dropouts to stay in or return to school. An average offer of US

Designing Experiments to Measure Spillover Effects

10/month conditional on satisfactory school attendance - plus direct payment of secondary school fees - led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after just one year of program implementation. For program beneficiaries who were out of school at baseline, the probability of getting married and becoming pregnant declined by more than 40 and 30%, respectively. In addition, the incidence of the onset of sexual activity was 38% lower among all program beneficiaries than the control group. Overall, these results suggest that CCT programs not only serve as useful tools for improving school attendance but may also reduce sexual activity, teen pregnancy, and early marriage.

Worms at Work: Long-Run Impacts of a Child Health Investment

We investigate the effects of a positive income shock on mental health among adolescent girls using evidence from a cash transfer experiment in Malawi. Offers of cash transfers strongly reduced psychological distress among baseline schoolgirls. However, these large beneficial effects declined with increases in the transfer amount offered to the parents conditional on regular school attendance by the adolescent girls. Improved physical health, increased school attendance, personal consumption, and leisure contributed to the effects. There was also strong evidence of increased psychological distress among untreated baseline schoolgirls in treatment areas. All of these effects dissipated soon after the program ended.

The heterogeneous effects of HIV testing

Cash transfer programmes are a popular social protection tool in developing countries that aim, among other things, to improve education outcomes in developing countries. The debate over whether these programmes should include conditions has been at the forefront of recent policy discussions. This systematic review aims to complement the existing evidence on the effectiveness of these programmes in improving schooling outcomes and help inform the debate surrounding the design of cash transfer programmes. Using data from 75 reports that cover 35 different studies, the authors find that both conditional cash transfers (CCTs) and unconditional cash transfers (UCTs) improve the odds of being enrolled in and attending school compared to no cash transfer programme. The effect sizes for enrolment and attendance are always larger for CCTs compared to UCTs, but the difference is not statistically significant. When programmes are categorised as having no schooling conditions, having some conditions with minimal monitoring and enforcement and having explicit conditions that are monitored and enforced, a much clearer pattern emerges whereby programmes that are explicitly conditional, monitor compliance and penalise non-compliance have substantively larger effects (60% improvement in odds of enrolment). Unlike enrolment and attendance, the effectiveness of cash transfer programmes on improving test scores is small at best. More research is needed that examines longer-term outcomes such as test scores and, more generally, evaluating the impacts of UCTs.

Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition

As of 2007, 29 developing countries had some type of conditional cash transfer program in place, with many others planning or piloting one. However, the evidence base needed by a government to decide how to design a new conditional cash transfer program is severely limited in a number of critical dimensions. This paper presents one-year schooling impacts from a conditional cash transfer experiment among teenage girls and young women in Malawi, which was designed to address these shortcomings: conditionality status, size of separate transfers to the schoolgirl and the parent, and village-level saturation of treatment were all independently randomized. The authors find that the program had large impacts on school attendance: the re-enrollment rate among those who had already dropped out of school before the start of the program increased by two and a half times and the dropout rate among those in school at baseline decreased from 11 to 6 percent. These impacts were, on average, similar in the conditional and the unconditional treatment arms. Although most schooling outcomes examined here were unresponsive to variation in the size of the transfer to the parents, higher transfers given directly to the schoolgirls were associated with significantly improved school attendance and progress - but only if the transfers were conditional on school attendance. There were no spillover effects within treatment communities after the first year of program implementation. Policymakers looking to design cost-effective cash transfer programs targeted toward young women should note the relative insensitivity of these short-term program impacts with respect to conditionality and total transfer size.

Economics of Mass Deworming Programs

This paper formalizes the design of experiments intended specifically to study spillover effects. By first randomizing the intensity of treatment within clusters and then randomly assigning individual treatment conditional on this cluster-level intensity, a novel set of treatment effects can be identified. The paper develops a formal framework for consistent estimation of these effects, provides explicit expressions for power calculations, and shows that the power to detect average treatment effects declines precisely with the quantity that identifies the novel treatment effects. A demonstration of the technique is provided using a cash transfer program in Malawi.