Cash transfer programs can improve household food consumption and diet diversity, but their impact on child anthropometric outcomes is inconsistent. While some studies find cash transfers increase birth weight and child height, effects on child food intake are rarely reported. The size, timing, and frequency of cash transfer benefits are important design features, but often are not well-aligned with nutrition goals in India. Implementation challenges include delays in payments, insufficient transfer amounts to cover costs of participation, and infrequent payment schedules that do not support early childhood nutrition.

1. Global Evidence on Effectiveness of
Cash Transfers for Nutrition
Urvashi Wattal
J-PAL South Asia
Based on an evidence review for the Cash Transfer for Child Health Initiative

2. I. Overview of the Global
Evidence
II. Implementation Challenges

3. Cash Transfers for Nutrition: Evidence Base
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
# of Studies: 48
Experimental
and Quasi-
Experimental

4. Cash transfers can improve food intake
• Global review of evidence suggests both CCTs and UCTs improve HH
food consumption and diet diversity across multiple contexts1.
– However, studies rarely report child food intake2
• CTs (mostly in Latin America) provided during pregnancy or early
childhood can increase birth weight and child height3
– Vulnerable populations (young mothers, premature babies) seem
to benefit most
– In utero nutrition is an important channel4 consistent with larger
literature on early life inputs.
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
1Bastagli et al 2016, de Groot et al 2015, De Walque, et al. 2017, Manley et al 2016, Pega, et. al 2017, 2 de Groot
et al 2015, 3Amarante, et. al 2016, Attanasio, et. al 2005, Barber and Gertler 2010, 4Amarante, et. al 2016

5. However, impacts of cash transfers on anthropometric
outcomes are inconsistent
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
1de Groot, Palermo, and Handa, 2015; 2Barham, Macours, and Maluccio 2013; Baird, McIntosh, and Ozler 2016,
Bastagli, et. al 2016; De Walque, et. al 2017; 3Manley, Gitter, and Slavchevska 2013; 4 De Walque et al., 2017,
Bastagli et al, 2016
• Effects on child food consumption might not match HH1
• Parental preferences
• Parental/Caregiver knowledge
• Sometimes, CTs do improve child consumption, but not
anthropometric outcomes:
• Design features (such as size, timing, frequency) 2
• Limited absorption due to chronic poor health2
• Some studies argue they find no effects, but this could be due to lack
of statistical power; might not be true null effects.4

6. I. Overview of the Global
Evidence
II. Implementation Challenges

7. Scope
1. Condition and/or cash transfer target
(directly/indirectly) under-five health
2. Active anytime between 2005-2016
Methods
1. Desk Review, JSY Case Study
2. Semi-structured interviews with key stakeholders
Scope and Approach
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
State-introduced CTs
CCTs UCTs
Maternity
Benefits
10 Active programs
6 Inactive
4 Active programs
Girl Child 4 Active programs
3Inactive
1 Active programs

8. IMPLEMENTATION CONSIDERATIONS FOR NUTRITION CASH
TRANSFERS
I. TARGETING AND ELIGIBILITY
II. BENEFITS STRUCTURE
III. CONDITIONALITIES
IV. PAYMENT MECHANISM
V. ROLE of FLWs
VI. ROLE OF INFORMATION CAMPAIGNS
VII. QUALITY OF CARE
VIII. MONITORING SYSTEMS
IX. GRIEVANCE REDRESS

9. IMPLEMENTATION CONSIDERATIONS FOR NUTRITION CASH
TRANSFERS
I. TARGETING AND ELIGIBILITY
II. BENEFITS STRUCTURE
III. CONDITIONALITIES
IV. PAYMENT MECHANISM
V. ROLE of FLWs
VI. ROLE OF INFORMATION CAMPAIGNS
VII. QUALITY OF CARE
VIII. MONITORING SYSTEMS
IX. GRIEVANCE REDRESS

10. Benefit structure
Amount, duration, timing, & frequency
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
• Is the benefit structure aligned to the programme goals & objectives?
• Are the transfers paid out within the stipulated time frame?
• Should the transfer size be adjusted to prevent erosion of purchasing power?
Key Implementation considerations

11. Benefit structure
Amount, duration, timing, & frequency
Alignment with Programme Goals and Objectives
• Benefit structure of CTs in India often not aligned to
programme goals:
– For instance, nutrition targeted transfers need to be
delivered in early childhood period and provided at
regular frequency, but often paid out or retrieved in
lumpsum.
– A study on Tamil Nadu’s maternity benefit scheme found
that 1st tranche of the transfer was only delivered in 7th
month
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
Insights from CTs in India

12. Benefit structure
Amount, duration, timing, & frequency
Timeliness of Delivery
• Payment delays are pervasive, which likely undermines programme
performance
• Often benefits are NOT administered as designed
– Two or more tranches paid out at one go
– Transfer amount differs from that entitled to
• Reasons for delays: Paper-based enrollment and condition
verification observed in studies on Maternal CTs in Tamil Nadu and
Jharkhand
• Additional challenges: Access to Bank accounts, Aadhar seeding,
incorrect beneficiary details
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
Insights from CTs in India

13. Benefit structure
Amount, duration, timing, & frequency
Adjusting for Erosions in Purchasing Power
• The transfer amount may not be sufficient to cover the costs of participation
(monetary and non-monetary)
– Including, transportation costs, costs associated with cashing out, costs
of condition compliance
– Process Monitoring study of CTs in the PDS found that the cash equivalent of
the entitlement was insufficient to purchase the same quantity of food, due to
costs of accessing transfer and purchasing from the market
– For only seven states, JSY incentive covers 60 percent or more of the out-of-
pocket expenses incurred on institutional delivery
• For nutrition CTs there is additional concern of ease of travel to cash out during
pregnancy
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS
Insights from CTs in India

14. • Payment frequency and timing:
– Critical to ensure that payments are made in a timely
manner – this is a non-trivial problem.
– Especially critical since evidence suggests timing of CT
crucial for nutrition.
• Payment amount: CT size should take into account temporal and
geographic variations in per capita consumption, income and
costs incurred
• Payment Mechanisms: Reduce the costs of retrieving the
transfers, Important to provide beneficiaries multiple avenues for
cashing out.
Key Takeaways on Benefit Structure
J-PAL SOUTH ASIA | EVIDENCE ON IMPLEMENTATION OF CTS