Evaluating three stylised interventions

Conditional cash transfer programs and household labor supply

Social policy and social protection systems were conceived as tools to address social risks and manage systemic asymmetries in capitalist societies. The last few decades have witnessed the feminization of anti-poverty public policies in the form of conditional cash transfer (CCT) programs. Since the late 1990s, CCT programs have been implemented to address income poverty in the short run, to interrupt the intergenerational reproduction of poverty in the long run, and to promote women’s economic empowerment. Feminist scholars recognize the positive impacts of CCTs on the lives of women that can lead to a reduction in gender inequality. The controversial and ambiguous nature of CCT programs for women has enabled discussions on how their positive aspects can be enhanced and their negative aspects reviewed. Part of the discussion includes an analysis of the possibility of moving toward universal unconditional cash transfer schemes, such as universal basic income.

Under the administrations of Fernando Henrique Cardoso (1995–2002) and especially President Lula (2003–), conditional cash transfer (CCT) programmes have become adopted as mainstream social policy in Brazil. This follows a marked trend since the 1990s in Latin America towards the setting up of targeted safety nets to alleviate poverty. Lula consolidated and expanded CCTs, firstly under Fome Zero and later Bolsa Família, now the largest such scheme in the world. Its four sub-programmes (educational stipends to boost school attendance, maternal nutrition, food supplements and a domestic gas subsidy) benefit some 30 million of Brazil's poorest people, with a target of 44 million by 2006. Since 2003, spending on Bolsa Família has risen significantly to consume over one-third of the social assistance budget for the poorest sectors and it remained a flagship policy in the run-up to the presidential elections of October 2006. Although coverage of Bolsa Família is impressive, however, systematic evaluation of its social and economic impacts is still lacking. Evidence from other CCT programmes in Latin America suggests that positive results may be achieved in terms of meeting some immediate needs of the poor. However, there have been many implementation problems. These include poor beneficiary targeting, lack of inter-ministerial coordination, inadequate monitoring, clientelism, weak accountability and alleged political bias. Given the heightened profile of cash transfers in Brazil's social policy agenda, key questions need to be asked. These concern, firstly, the extent to which Bolsa Família does indeed contribute to poverty alleviation; and secondly, whether it creates greater dependence of the poor on government hand-outs and political patronage at the expense of long-term social investment for development.

The last two decades witnessed an unprecedented decline in poverty across the developing world, a decline partly explained by the adoption of social cash transfer programs. Ironically, Latin America, traditionally the world’s most unequal region, has been a global trendsetter in this regard. Beginning in the late 1990s, governments across the region and across the ideological spectrum began adopting conditional cash transfer (CCT) programs, which award poor families regular stipends conditional on their children attending school and/or getting regular medical check-ups, and non-contributory pension (NCP) schemes for low-income and/or uncovered seniors. There is robust evidence that CCT programs achieve their short-term goals of reducing poverty while increasing school attendance and usage of health services. However, they do not improve learning and appear to be failing at their long-term goal of breaking the intergenerational transmission of poverty. Likely as a result of low-quality education, long-term CCT beneficiaries do not have significantly better economic prospects than comparable non-beneficiaries. CCTs also have electoral effects—there is robust evidence from across the region that they increase support for incumbent presidential candidates. CCTs were a response to the two big transformations the region underwent during the 1980s: the debt crisis and subsequent lost decade and the transition of most countries to democracy. Increased economic insecurity following the crisis and subsequent neoliberal reforms represented both a threat to the survival of newly elected governments and an opportunity for politicians to win over voters through increased social assistance. Pioneered by Mexico and Brazil in the mid-1990s, CCTs were by far the most effective policies to emerge from that context. They quickly diffused across the region, often with support from international financial institutions. Counterintuitively, adoption appears to be unrelated to the ascendance of left-wing governments in the region during the 2000s. The politics of CCT design are less understood. The myriad ways in which design can be conceptualized and measured, combined with the relative newness of this literature, have limited the accumulation of knowledge. It does appear that left-wing governments adopt more expansive CCTs and de-emphasize conditionality enforcement. Whereas their initial adoption and expansion, which coincided with the 2000s economic boom, proved politically easy, further reductions in poverty will require politically difficult choices, namely, raising taxes and/or redirecting funds away from programs benefiting the better-off. Improving the long-term effectiveness of CCTs will require improving education quality, which in turn will require challenging the region’s powerful teachers’ unions.

We conducted a choice experiment (CE) to estimate willingness to accept (WTA) values for a planned conditional cash transfer (CCT) programme designed to increase toilet use in South Africa. The payment is made conditional on using a toilet and bringing urine to a central collection point. In a split-sample approach, a segment of respondents were given time to think (TTT) (24 hours) about their responses, while the remaining respondents had to answer immediately. We found significant differences in the choice behaviour between the subsamples. To validate the stated preferences with actual behaviour, a CCT programme was implemented afterwards. The stated WTA estimates were far below those revealed by actual behaviour for both subsamples. Contrary to our expectations, the TTT group had underestimated their actual WTA values by an even larger margin. The preferences for various attributes were nevertheless useful in informing the design of the real intervention.

Key LessonsConditionality is a key element of conditional cash transfer (CCT) programs and its use has broad political and social appeal. The use of intermediate indicators for ease of implementing conditionality and monitoring (e.g. school enrollment or visits to the clinic) may not fully capture the desired long-term outcomes (e.g. learning achievement or health indicators). The parallel for REDD+ is in choosing between simpler input-based conditionality indicators (e.g. number of trees planted, number of monitoring surveys carried out) or long-term outcome-based indicators (e.g. forest cover maintained, amount of carbon emissions reduced).Conditionalities can create substantive costs and there is mixed evidence on their effect. Their relevance and feasibility depend on contextual factors such as politics, and the feasibility, desirability and capacity of countries to set and monitor conditions.CCT programs often experience tension between efficiency and equity, where more complex eligibility criteria to ensure equity outcomes will entail higher costs to implement and to monitor. There is a similar tension for REDD+ in realizing objectives for effectiveness (e.g. households who are eligible based on their expected deforestation behavior) and equity (e.g. reaching the poorest households).Additionality is an important component of CCT programs, and there is some evidence of positive spillovers on the behavior and consumption of households that do not receive the transfer. The magnitude of these spillovers depends on uptake rates, counterfactual compliance and distribution of the opportunity costs of compliance. For REDD+, there is a risk of negative spillovers if targeting is perceived as unfair, particularly by those who may be non-eligible because of the non-additionality of their behavior before payments (e.g. forest stewards).The effect of additional cash inflows into a household economy has in some cases led to changes in consumption preferences that can have a negative impact on the environment, and in the case of REDD+, this could result in displacement of forest degradation activities elsewhere.Evidence from CCT programs suggests that packaging complementary measures may be an effective way to address multiple goals of improved health and education outcomes with poverty alleviation and resilience to risks. The potential for linking REDD+ with social measures is an attractive solution to avoid over-burdening the REDD+ agenda.

¿En qué medida las transferencias condicionadas (TMC), programas “estrella” de la nueva generación de la política social latinoamericana, inhiben o promueven mayores grados de igualdad de género? Usando un instrumento teórico-empírico novedoso, y a partir de fuentes primarias y secundarias, nuestro análisis compara tres países con regímenes de bienestar contrastantes: Chile, Costa Rica y El Salvador. Mostramos que, aunque en términos de la igualdad de género, los programas TMC se basan en supuestos que en principio exacerban la histórica división del trabajo entre hombres y mujeres, también pueden transformarla.

As a social protection mechanism, various programmes have been designed to address the challenges faced by the poorest members of society. This study assesses the effectiveness and challenges of the Conditional Cash Transfer (CCT) programme for vulnerable populations in Bayelsa State, Nigeria. The study was anchored on the Human Capital Theory and based on primary and secondary data. Primarily, data were collected from the Conditional Cash Transfer beneficiaries with the aid of a questionnaire. On the other hand, Key-Informant Interviews (KIIs) were used for the qualitative data collection. Data were analysed using descriptive statistics and Thematic content analysis. Findings reveal that the CCT programme significantly improved the economic status and living conditions of beneficiaries, particularly women. However, challenges such as delayed disbursements hindered effective implementation. Despite its modest financial support, the CCT programme made a significant contribution to poverty alleviation. The study recommends timely fund disbursement to enhance the programme. Received: 15 September 2025 / Accepted: 26 October 2025 / Published: November 2025

This systematic review and meta-synthesis assesses the effectiveness of Conditional Cash Transfers (CCTs) and Unconditional Cash Transfers (UCTs) in Sub-Saharan Africa. Analyzing 27 studies (2014–2024) using PRISMA guidelines, the research examines impacts on financial stability, education, and health. CCTs generally outperform UCTs in achieving specific education and health targets by incentivizing behaviors, while UCTs offer greater flexibility, improving mental health and economic resilience in fragile settings. The findings stress the context-dependent nature of cash transfer programs and the need for tailored, integrated approaches. Policy recommendations emphasize designing programs based on local conditions and desired outcomes.

BackgroundOptimizing retention in human immunodeficiency virus (HIV) treatment may require sequential behavioral interventions based on patients’ response.MethodsIn a sequential multiple assignment randomized trial in Kenya, we randomly assigned adults initiating HIV treatment to standard of care (SOC), Short Message Service (SMS) messages, or conditional cash transfers (CCT). Those with retention lapse (missed a clinic visit by ≥14 days) were randomly assigned again to standard-of-care outreach (SOC-Outreach), SMS+CCT, or peer navigation. Those randomly assigned to SMS or CCT who did not lapse after 1 year were randomly assigned again to either stop or continue the initial intervention. Primary outcomes were retention in care without an initial lapse, return to the clinic among those who lapsed, and time in care; secondary outcomes included adjudicated viral suppression. Average treatment effect (ATE) was calculated using targeted maximum likelihood estimation with adjustment for baseline characteristics at randomization and certain time-varying characteristics at rerandomization.ResultsAmong 1809 participants, 79.7% of those randomly assigned to CCT (n=523/656), 71.7% to SMS (n=393/548), and 70.7% to SOC (n=428/605) were retained in care in the first year (ATE: 9.9%; 95% confidence interval [CI]: 5.4%, 14.4% and ATE: 4.2%; 95% CI: −0.7%, 9.2% for CCT and SMS compared with SOC, respectively). Among 312 participants with an initial lapse who were randomly assigned again, 69.1% who were randomly assigned to a navigator (n=76/110) returned, 69.5% randomly assigned to CCT+SMS (n=73/105) returned, and 55.7% randomly assigned to SOC-Outreach (n=54/97) returned (ATE: 14.1%; 95% CI: 0.6%, 27.6% and ATE: 11.4%; 95% CI: −2.2%, 24.9% for navigator and CCT+SMS compared with SOC-Outreach, respectively). Among participants without lapse on SMS, continuing SMS did not affect retention (n=122/180; 67.8% retained) versus stopping (n=151/209; 72.2% retained; ATE: −4.4%; 95% CI: −16.6%, 7.9%). Among participants without lapse on CCT, those continuing CCT had higher retention (n=192/230; 83.5% retained) than those stopping (n=173/287; 60.3% retained; ATE: 28.6%; 95% CI: 19.9%, 37.3%). Among 15 sequenced strategies, initial CCT, escalated to navigator if lapse occurred and continued if no lapse occurred, increased time in care (ATE: 7.2%, 95% CI: 3.7%, 10.7%) and viral suppression (ATE: 8.2%, 95% CI: 2.2%, 14.2%), the most compared with SOC throughout. Initial SMS escalated to navigator if lapse occurred, and otherwise continued, showed similar effect sizes compared with SOC throughout.ConclusionsActive interventions to prevent retention lapses followed by navigation for those who lapse and maintenance of initial intervention for those without lapse resulted in best overall retention and viral suppression among the strategies studied. Among those who remained in care, discontinuation of CCT, but not SMS, compromised retention and suppression. (Funded by National Institutes of Health grants R01 MH104123, K24 AI134413, and R01 AI074345; ClinicalTrials.gov number, NCT02338739.)

Conditional cash transfers (CCT) are paid to parents, whose compulsory school -age children regularly attend school. When schooling requirements are not met, the transfer is suspended and parents are often required to pay back the allowance subsequently. The general aims of CCTs are: improving children’s school participation, extending the time that children spend in public education and reducing the number of early school leavers. My dissertation analyses the implementation, proliferation and operation of different European education-based cash transfer programmes, which function as novelties in the modern continental welfare policies. My research is based on TÁRKI’s evaluation of the European CCTs that was conducted on behalf of the European Commission in 2013 and 2014. I participated as a researcher in this project. The first research question of my dissertation is: How did the international financial organizations influence the proliferation of CCTs in the analysed European countries? The next question is: Why did governments prefer CCTs compared to other possible programmes as a way to tackle early school leaving and truancy? Another important question is: Which social groups are the most affected by the sanctions of CCTs? And my last question is: How certain educational indicators changed after the introduction of the conditional transfers? In order to answer these questions I carried out case studies on education based cash transfer programmes in three countries: Child Allowance in Bulgaria, School Allowance in Hungary and School Allowance in Belgium’s Flemish Region. During my research I thoroughly analysed policy documents relating to the programmes (national and international strategies, action plans, legal documents, publications, etc.) and carried out qualitative interviews with governmental officers and civil experts from all three countries. Though my analysis does not show a direct relationship between the implementation of CCTs and the activity of international organizations (European Union, World Bank, IMF), the general impact of these organizations on the formation of welfare policies in the analysed countries is rather significant. At the same time, national decision makers and the public opinion – particularly in the eastern European countries – strongly support the implementation of education-related family benefits. Moreover, my research draws attention to the phenomenon, that the CCT related sanctions punish primarily the most vulnerable social groups in each of the countries, such as the poor, the ethnic minorities and people from disadvantaged geographic regions. In addition, CCT programmes – at least the ones analysed in my thesis - are not successful at reducing early school leaving and school drop-out and cannot keep children at schools longer.

During the past decade, the use of conditional cash transfers to increase investment in human capital has generated considerable excitement in both research and policy forums. Such schemes are being increasingly adopted in a number of contexts and countries to improve outcomes in health, education, and child labor as they aim to balance the goals of current and future poverty reduction. In this paper, the authors define any scheme requiring a specified course of action in order to receive a benefit as a conditional cash transfer. This definition includes cash transfers based on human capital investments, but is sufficiently broad to encompass other schemes such as work-fare programs or consumption transfers. The authors examine the rationales behind, the problems with, and the tradeoffs inherent to conditional cash transfer programs. They discuss two main concerns: low participation and fungibility. Low participation refers to the problem of program uptake. If individuals do not participate in the program, whether it was designed to increase human capital investment or to target resources, the program will not be successful. The problem of fungibility, however, depends on the rationale for the particular conditional cash transfer program. When used to increase efficiency, even when program uptake is high, program effects may be less than envisioned due to behavioral responses of households that lead to changes in the consumption of close substitutes. While researchers have typically addressed these issues separately, the authors emphasize the need for policymakers to incorporate a number of different factors in a comprehensive framework to design optimal conditional cash transfer schemes.

Unsuccessful tuberculosis outcomes are frequent; bold policies are needed to end the tuberculosis (TB) epidemic to attain the third Sustainable Development Goal (SDG) by 2030. We examined the effect of the Family Health Strategy (FHS) and its interactions with the conditional cash transfer programme (CTP) on TB outcomes in Rio de Janeiro, Brazil. We performed individual-based analyses of a database resulting from deterministic and probabilistic linkages of the TB information system, FHS registries and CTP payrolls. Patients ≥15 years old treated with the standard RHZE regimen were included. The rates of successful outcomes were analysed according to coverage by FHS. Effects from the CTP and its interactions with the FHS were examined among the poorest. FHS coverage increased the likelihood for successful outcomes by 14% (12-17%) among 13 482 new cases, and by 35% (25-47%) among 1880 retreatment cases. The CTP had an independent effect but no interaction with the FHS among the poorest. This is the first individual-based study to show a relevant protection of poor urban communities regarding patient-important health outcomes by the Brazilian FHS and CTP. These findings support strategies of universal health coverage, primary care strengthening and social protection to achieve a major SDG.

In the past decade, conditional cash transfer (CCT) programs have become an important component of social policy in developing countries. While the impacts of these programs have been well researched with respect to their effectiveness to achieve intended outcomes, less is known about their impact on private expenditure decisions. This aspect has great policy relevance since changes in private household expenditures can either support or counteract the aim of the programs. This essay investigates the impact of a CCT program on private household expenditure decisions in nutrition, health and education which are seen as principal contributors to child human capital. First, household expenditure behavior under a CCT program is discussed based on Heckman's model on the technology of skill formation as a conceptual framework. The paper shows how intra-household preferences and perceptions on the substitutability or complementarity of investments can impact household resource allocation decisions. Subsequently, the theoretical implications are tested in the context of the Brazilian CCT program Bolsa Familia, using the Brazilian household expenditure survey. Evidence is found that households increase their private expenditure in food and education disproportionally to the amount of cash transfer, that is, more than would be expected when considering the Engel curves of the expenditures under question.

Recent geopolitical and economic changes have altered global social policy formation. The Bretton Woods multilateral development agencies (MDAs) have selectively incorporated ideas emerging from developing country states and decision makers, with a recent increased acceptance of social transfers as part of renewed efforts at poverty alleviation based on social risk management. There has been an instance in the use and promotion of conditional cash transfer (CCT) policies by MDAs. CCTs were a product of the emergence of a neo-structuralist welfare regime (understood as an ideal type) in Latin America – an attempt to reconcile neoliberal strategies of development with aspirations for guaranteed minimum incomes. The Bretton Woods and regional development bank MDAs have facilitated the adoption of CCTs in other developing countries, including the Phillipines. Here, a combination of actions by national political actors and MDAs has resulted in the implementation of a securitised and compliance-focused version of CCTs derived from the Colombian security state. Although poor Philippine households welcome income assistance, CCTs have acted to enforce further state monitoring without altering the national-based political and economic processes that replicate poverty.