Partnership for Child Development & World Bank, Wellcome Trust, UNICEF. Zimbabwe , Manicaland HIV/AIDS Prevention Project team, Catholic Relief. Services ...
Conditional cash transfers improve birth registration and school attendance amongst orphans and vulnerable children in Manicaland, Zimbabwe Laura Robertson1, Phyllis Mushati2, Jeff Eaton1, Morten Skovdal3, Lovemore Dumba4, Gideon Mavise4, Mr Makoni5, Christina Schumacher1, Tom Crea6, Roeland Monasch7, Lorraine Sherr8, Geoff Garnett1, Constance Nyamukapa1,2, Simon Gregson1,2 1Department
of Infectious Disease Epidemiology, Imperial College London, 2Biomedical Research & Training Institute, 3Department of Health Promotion & Development, University of Bergen, 4Catholic Relief Services, Harare, Zimbabwe, 5DOMCCP, Manicaland, Zimbabwe, 7Graduate School of Social Work, Boston College, 7UNICEF, Zimbabwe, 8Department of Infection & Population Health, University College London
INTRODUCTION
METHODS
In 2009, there were an estimated 1.2 million people living with HIV in Zimbabwe & 84,000 deaths due to AIDS (UNAIDS). The HIV epidemic & severe economic problems have increased child vulnerability through exposure to extreme poverty & HIV-related illness, stigma & death within families & communities.
Analysis: Intention-to-treat analysis. Cluster-level linear regression models adjusted for matched study design were used to estimate the effect of the interventions on the following endpoints: % of children < 5 years in vulnerable households with a birth certificate; % of children < 5 years in vulnerable households with up-to-date vaccinations; % of children 6-12 years in vulnerable households attending school >= 80% of days per month; % of children 6-12 years in vulnerable households attending school >= 80% of days per month.
In 2009/11, we conducted a cluster-randomised controlled trial of unconditional (UCT) & conditional (CCT) cash transfer programmes for households caring for orphans & other vulnerable children (OVC) in Manicaland, eastern Zimbabwe.
METHODS
TABLE 1: Effects of UCT & CCT programmes on the trial endpoints
Study design: 30 predominantly rural clusters were matched on socioeconomic characteristics & randomised to one of three study arms: UCT, CCT & control. Baseline household census completed in September 2009 & follow-up completed in May 2011. Eligibility: Households were eligible for the programmes if they cared for at least one child < 18 years, were not in the richest quintile of households and met one or more of the following criteria: in poorest quintile of households; cared for at least one orphan (< 18 years); household head < 18 years; chronically ill or disabled household member (any age). Intervention (UCT & CCT): Eligible households in the intervention arms received US$18 every two months plus an extra $4 per child to a maximum of 3 children. Cash collected by beneficiaries from pay points near their homes. Intervention (CCT): Eligible households in CCT arm monitored for compliance with conditions: birth certificates for children < 18 years including newborns within 3 months; children < 5 years up-to-date with vaccinations & attend growth monitoring twice per year; children 6-17 years attend school >= 90% of school days per month; 1 adult attend 2/3 parenting skills classes.
FIGURE 2: Effects of UCT & CCT programmes on the trial endpoints (N=30 [10 matched triplets]) A: Effect of UCT & CCT programmes on the percentage of children aged 0-4 years with complete vaccination records. B: Effect of UCT & CCT programmes on the percentage of children aged 0-4 years with a birth certificate.
6 month grace period at start – conditions not monitored. After this, conditions were monitored every 2 months. Non-compliant households were initially offered support from an NGO. If they continued in default, they were assigned a community volunteer for further assistance. After six months in default, their cash transfers were reduced by 10%. After 8 months in default, the community volunteer assumed responsibility for the cash until the household could meet their conditions.
C: Effect of UCT & CCT on the percentage of children aged 6-12 years attending school 80% or more of days in the last month.
FIGURE 1: Flow diagram – clusters & households
D: Effect of UCT & CCT on the percentage of children aged 13-17 years attending school 80% or more of days in the last month.
RESULTS & CONCLUSIONS Results: Figure 1 shows the flow of households through the trial. 90% of eligible households in the UCT arm & 97% in the CCT arm reported receiving cash transfers in 2010. 83% of eligible households in the CCT arm reported having to meet conditions & 35% reported being assigned a volunteer. Baseline characteristics were similar across the three trial arms for most indicators, although there were small variations in the proportion of children 0-4 years that were female & the proportion of children 13-17 years attending school 80% of days or more.
ACKNOWLEDGEMENTS Partnership for Child Development & World Bank, Wellcome Trust, UNICEF Zimbabwe , Manicaland HIV/AIDS Prevention Project team, Catholic Relief Services Zimbabwe, DOMCCP & our study participants.
Table 1 & figure 2 show the effects of the UCT & CCT programmes on the four trial endpoints. Further analyses adjusting for cluster-level baseline proportions of the endpoints & any indicators unbalanced at baseline produced results consistent with those presented above. Conclusions: Cash transfer programmes, particularly conditional transfers, increased birth registration & school attendance in a low income, high HIV prevalence setting.
