Presentación de John Hoddinott and Lucy Bassett, International Food Policy Research Institute IFPRI, durante el Tercer Seminario de Transferencias Condicionadas de Ingresos, realizado en Santiago de Chile el 01 y 02 de Diciembre de 2008.

1. Conditional Cash Transfer Programs and Nutrition in Latin
America: Assessment of Impacts and Strategies for
Improvement
John Hoddinott and Lucy Bassett
International Food Policy Research Institute
December 2008

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Introduction
There are many reasons why improvements in the nutritional status
of pre-school children, and their mothers, should be part of
Conditional Cash Transfer (CCT) programs.
1) Improved nutrition has:
• Intrinsic value– Being well nourished is a “good thing”
• Instrumental value - Malnutrition has high costs in terms of poor health,
cognitive development and loss of earnings
2) The preschool period—in addition to the prenatal period—represents a
window of opportunity to improve nutrition that, if not taken, is lost.
3) There is evidence, discussed in our paper, that pre-school nutritional
status can be improved in the context of CCTs; and
4) There are a number of promising approaches that can make CCTS even
more powerful policy tools for reducing malnutrition in Latin America
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Dimensions of Malnutrition
In preschool children, nutritional status is often assessed in terms of
anthropometry. The basic principle of anthropometry is that prolonged or
severe nutrient depletion eventually leads to retardation of linear growth.
• Height-for-age reflects the cumulative impact of events affecting nutritional status
and thus is an indicator of chronic nutritional deprivation. The prevalence of low
height for age - stunting - has been falling in Latin America, but this trend masks
uneven progress across and within countries
Micronutrient status is another important dimension of nutrition. Of greatest
concern in Latin America are iron and zinc deficiencies and, to a lesser
extent, deficiencies in vitamin A.
• Adequate iron intake is necessary for brain development.
• Zinc deficiencies are associated increased risk of mortality and morbidity as well
as poor physical growth and neurobehavioral development.
• Lack of Vitamin A leads to increased severity of infections and higher mortality in
children.
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Role of CCTs in Combating Malnutrition
Well designed and implemented CCTS can combat malnutrition
through a number of mechanisms:
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Constraint Program Component
Mothers lack resources to purchase
nutritious foods
CCTs provide cash transfers to
mothers
Children’s diets are deficient in micro-
nutrients
Some CCTs provide micro-nutrient
dense food supplements or vitamins
Mothers lack knowledge of best care
practices
Some CCTs hold monthly meetings,
“platicas” at which health and nutrition
topics are discussed
Health services are of poor quality In addition to monetary transfers, some
CCTs improve the quality of health
services

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Impact of Selected CCTs on Nutrition: Programs, Data
and Methods
Our paper considers four CCTs that IFPRI has evaluated:
• PROGRESA – Mexico – using two rounds of household and anthropometric data
collected in 1998 and 1999 from households located in 342 localities
• Programa de Asignación Familiar – Fase II (PRAF-II) – Honduras – using two
rounds of household and anthropometric data collected from households located
in 70 localities in 2000 and 2002
• Red de Protección Social (RPS)– Nicaragua – using using two rounds of
household and anthropometric data collected from households located in 42
localities in 2000 and 2002
• Bolsa Alimentação (BA) – Brazil – anthropometric data were collected and
merged with records from health cards and administrative data
In three studies, Honduras, Mexico and Nicaragua, the core evaluation
method is a randomized design together with estimates of impact using
double differencing (ie compare change in children exposed to treatment to
changes in children in control localities)
In Brazil, matching methods were used
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Impacts
Stunting:
• The preponderance of evidence shows that PROGRESA reduced stunting in
children under 36 months; a conservative estimate being 7.3 – 10.0 percentage
points
• In Nicaragua, compared to children in control localities, stunting fell by 5.3
percentage points among children aged 0 to 5 years in RPS (treatment)
communities.
• PRAF in Honduras and BA in Brazil had essentially no effects on preschool
anthropometric status
Micronutrient deficiency – Iron status
• Two evaluations of PROGRESA show a large impact — reductions of 10.6 – 25.5
percent - on the probability of being anemic
• Neither PRAF-II nor RPS had an impact on blood hemoglobin levels or on rates
of anemia.
• The RPS results are of interest because an iron supplement was provided to
pre-school children. However, consumption of the supplement was low
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Design modifications: Stunting
Target group.
• Children 0-2
• Pregnant and lactating women
Key low cost modification: Improve quality of pláticas by
• Age-specific child feeding messages
• Hygiene and sanitation messages
• Take-home materials
Consider food supplements
Cautiously consider growth monitoring and promotion given its
mixed record
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Design modifications: Micronutrient deficiencies
Target group.
• Children 0-5
• Pregnant women
For Children:
• Zinc supplements
• Dispersible micronutrient preparations
For Pregnant women:
• Iron-folate with accompanying counseling to improve compliance
• Consider multiple-micronutrient supplements
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Design modifications: Stunting and micronutrient
deficiencies
Target group
• Children 0-2
Zinc supplements
• Improve morbidity and growth
Dispersible micronutrient preparations
• Chispitas, Sprinkles
• Improve iron status and encourage the timely introduction of
complementary feeding

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Conclusions
CCTs in Latin America have had important impacts on preschool
nutritional status, but their potential has not been met
Several low-cost, evidence-based design modifications could likely
improve CCT impacts on children’s growth and micronutrient status
These will require improvements in the quality of service delivery to
be effective