Final Report: The Impact of PROGRESA on Health

Publication Details

International Food Policy Research Institute (IFPRI), November 2000, Final Report. Available From:

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Author
Paul J.Gertler
Country
Mexico
Region
Latin America and the Caribbean
Sector
Health Nutrition and Population, Multisector, Social Protection
Subsector
Conditional Cash Transfers
Equity Focus
None specified
Evaluation design
Difference-in Difference (DID), Randomised Control Trials (RCT)
Status
Published Report

Methodology

This report assesses the impact of a Mexican conditional cash transfer programme on the health of rural household members. In 1997, the Mexican government launched Progresa, a national antipoverty programme aimed at improving the health, nutrition and school attendance of beneficiary households by offering financial incentives conditional on compliance with several requirements. Cash transfers for health and nutrition were conditioned on mothers participating in four types of programmes: (1) nutritional supplementation, (2) child growth monitoring, (3) preventive medical care and (4) education on health, hygiene and nutrition habits. Combined with the higher purchasing power entailed by cash transfers, these programmes create a potential for complementary effects on health outcomes for both children and parents. To uncover the existence of such effects, the study exploits data from a randomised experiment (RCT) conducted by Progresa from 1998 to 2003 in 506 rural localities.
The author evaluates the programme’s impact by using a difference-in-differences (DID) estimator, comparing the evolution of eligible households living in treatment villages before and after the implementation of Progresa with the evolution of eligible households in control villages. The study focuses on two general types of outcomes: the use of health care facilities (i.e., visits to clinics and nutrition monitoring visits) and health outcomes (i.e., child, adolescent and adult health). Difference-in-differences (DID) specifications vary in the function of the outcome under investigation, but all specifications include a set of time-varying control variables. The baseline survey was conducted by Progresa in March 1998 and includes a random sample of about 19,000 households (112,319 individuals) living in 320 treatment localities and 186 control localities. Progresa then conducted four follow-up surveys in 6-month intervals. The author also uses administrative records of health facilities located in treatment and control areas.

Main findings

The findings indicate that daily visits to public clinics in treatment localities doubled in comparison with control areas. More specifically, results show that there were about two more daily visits in treatment villages than in control villages and over 11 more visits per beneficiary household. Although the overall number of visits to public clinics increased by 30 to 50 per cent, it remained constant for children aged 0 to 2 years. Hospital visits for children aged 0 to 2 years fell by 58 per cent, which is seen by the author as consistent with the preventive goal of Progresa to reduce the occurrence of severe illnesses. In addition, the study reports that growth monitoring visits increased between 30 to 60 per cent for children aged 0 to 2 years and between 25 and 45 per cent for children aged 3 to 5 years.
The results on health outcomes show that the programme reduced illness rates by 12 per cent for children aged 0 to 2 years and by 11 per cent for children aged 3 to 5 years. However, no impact was observed on children and adolescents aged 6 to 17 years. The findings also show significant positive results on beneficiaries aged 18 to 50 years, who report 19 per cent fewer days of difficulty with daily activities due to illness than non-beneficiaries and a greater capacity to walk without getting tired: 7.5 per cent more kilometres relative to the control group. Similarly, beneficiaries over age 50 report 19 per cent fewer days of difficulty due to illness, 17 per cent fewer days incapacitated, 22 per cent fewer days immobilised in bed and a capacity to walk 7 per cent more kilometres than non-beneficiaries.

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