Tania Barham

Eradicating diseases: The effect of conditional cash transfers on vaccination coverage in rural Nicaragua.

Despite significant global efforts to improve vaccination coverage against major childhood diseases, vaccination rates are below 90%. To eradicate diseases such as measles, however, vaccination rates close to 95% are needed. We use a randomized experiment to investigate the effect of a demand incentive, a conditional cash transfer program, in improving vaccination coverage in rural Nicaragua. Double-difference estimates show the program led to large increases in vaccination coverage, and these resulted in vaccination levels greater than 95% for some vaccines. Effects were especially large for children who are typically harder to reach with traditional supply-side interventions.

Providing a Healthier Start to Life: The Impact of Conditional Cash Transfers on Infant Mortality

In this paper, I evaluate the impact of Mexicos conditional cash transfer program, Progresa, on infant mortality. While studies on other aspects of Progresa make use of a randomized treatment and control evaluation database performed in 506 communities, this database lacks sufficient sample size to measure the effect on infant mortality. Instead, I use vital statistics data to determine municipality-level, rural infant mortality rates and create a panel dataset covering the period 1992-2001. I take advantage of the phasing-in of the program over time both between and within municipalities to identify the impact of the program. I find that Progresa led to an 11 percent decline in rural infant mortality among households treated in Progresa municipalities. Reductions are as high as 36 percent in those communities where, prior to program interventions, the population all spoke some Spanish and had better access to piped water.

Beyond 80 percent : are there new ways of increasing vaccination coverage? evaluation of CCT programs in Mexico and Nicaragua

This study evaluates the impact of the Mexican conditional cash transfer (CCT) program, Oportunidades and the Nicaraguan program, Red de Proteccion Social, on vaccination coverage for Bacille Calmette-Guerin (vaccine against tuberculosis), Diphtheria-Pertussis-Tetanus Vaccine, Oral Polio Vaccine and Measles-Containing Vaccine in children less than three years of age, using a randomized treatment and control design at the community level. The intent-to-treat effect on vaccination coverage is assessed using a double-difference estimator. This study found that in Mexico and Nicaragua, CCTs significantly contribute to increased vaccination coverage among children, particularly among those not reached by traditional program strategies, such as children living further from health facilities and with mothers having less than primary school

Making Babies Healthier By Providing a Managed Care Option to California's Poor

The first chapter investigates whether mandating a managed care option for California Medicaid beneficiaries improves access to prenatal care and birth outcomes in a traditionally fee-for-service system. We compare two competing models: one that only offers a county-organized health system option (COHS), and the Two Plan Model (TPC) that provides mothers with a choice between the county system and a commercial managed care organization. The results show that while COHS improved access, only the TPC program led to reductions in low-birth weight. The superior health outcomes obtained with TPC might be explained by higher quality care induced by competition among health providers and/or mainstreaming Medi-Cal beneficiaries into commercial organizations that also serve higher income populations.

Long-term Impacts of Conditional Cash Transfers in Latin America: Review of the Evidence

We review the literature on the long-term impacts of Conditional Cash Transfer (CCT) programs in Latin America. Long-term impacts are defined as those that both: 1) are related to the accumulation of human capital, and; 2) are observed after beneficiary children have reached a later stage of the life-cycle. We focus on two life-cycle transitions. The first is children exposed to CCTs in utero or early childhood, who have then transitioned to school ages. The second is children exposed to CCTs during school ages, who have then transitioned to early adulthood. The evidence is inconclusive. The experimental literature finds consistent positive long-term effects on schooling, as well as some positive impacts on cognitive skills and learning, socioemotional skills and off-farm employment and income. However, many other estimates are not statistically different from zero and it is often not possible to discern whether this is due to lack of impact or to methodological shortcomings in the evaluation studies. Non-experimental evidence also is mixed. Developing further opportunities for analyses with rigorous identification strategies for the measurement of long-term impacts should be high on the research agenda. As original beneficiaries continue to age, this should also be increasingly possible.