Conditional Cash Transfer Programs (CCTs) in Hindsight
Poverty was regarded to be the root cause of various world problems. Director of
Colombia’s Department of Social Prosperity, Tatyana Orozco, described poverty as a
multidimensional problem (Multidimensional Poverty Peer Network, 2017). It is
associated with forms of deprivation—from health, food security, education, voice, rights,
and dignity—that hinders progress (Organisation for Economic Co-operation and
Development, 2001). Given the circumstance, poverty alleviation programs, such as
conditional cash transfers (CCTs), were developed.
CCTs are cash transfer programs that provides financial assistance to households, on
certain conditions, usually involving investment on children’s human capital (Fiszbein et
al., 2009). Conditions may include regular attendance of children to school, and constant
monitoring of health and nutrition condition (WHO, 2019). In some countries, such as the
Philippines, parents were even made to attend and participate on workshops (World
Bank, 2014). Moreover, CCTs were developed in the context of alleviating poverty while
trying to eradicate the intergenerational cycle of poverty in poor households (Heimo,
2014). However, similar, policy and conditions of CCTs varies from country to country
according to context in their locales (Fiszbein et al., 2009).
Brief History of CCTs
In the 1980s, the occurrence of the Latin American Debt Crises has pushed the region
into a deep recession leaving millions of Latin Americans jobless and poor (Sims, 2013).
This event has led to the development of poverty alleviation programs that allows the
private sector and foreign capital to invest on children’s health and education, that opened
doors for conditional cash transfer programs (Korzeniewicz & Smith, 2000).
In 1995, Brazil’s Bolsa Escola pioneered the emergence of conditional cash transfer
programs—though in provincial level only (Lindert et al., 2007). In 1997, Mexico made a
groundbreaking move by launching a CCT program on national level in Progresa, now
Oportunidades, providing aid to 300,000 households in 6,344 localities in the 12 states
(Levy, 2006). By 2008, CCT programs were all over Latin America and have made their
way to Asia and Africa, with countries such as Nigeria, Yemen, Indonesia, India, and the
Philippines adapting CCTs in their social assistance programs (Fiszbein et al., 2009). In
2014, CCT programs have reached almost 70 nations in the world, including countries in
North and South America, Asia, Africa, and even Europe (World Bank, 2014).
Conditional Cash Transfer Programs on Poverty Alleviation, Health and Nutrition
The emergence of different CCTs all over the world in the last two decades has seen
mostly beneficial results. In the first wave of cash transfers in Latin American countries,
positive impacts were seen, Colombia’s poverty rate dropped by 3 percent in 4 years,
while Nicaragua’s CCT participants from below poverty line households have lessen to 5
percent in two years (Saavedra, 2016). Household productivity, and diversification of
household economic activities has increased for beneficiary households of CCTs (Orozco
Corona & Gammage, 2017). So far, CCTs have been an effective tool for poverty
alleviation and have increased the probability of ending generational poverty among its
beneficiaries (Kugler, 2017).
CCTs has been successful in easing the burden of poverty among beneficiary
households, however, current evidence drawn mixed conclusions in proving its positive
impacts on health and nutrition. Manley and Slavchevska (2013) described CCTs to have
such inconsistent effects on a child nutrition. Findings of Tabuga and Reyes (2012) have
seen a positive effect on medical service accessibility but manifested uneven outcomes
on children’s health and nutrition status. In terms of food security, receipt of cash transfers
has seen an increase in food security (Raghunathan et al., 2017). However, conditional
cash transfers have increased consumption of processed foods among beneficiaries (De
Lima et al., 2019). On the other hand, evidence from Brazil’s conditional cash transfer
programs have shown relatively positive impacts on diet and nutrition and have seen an
increased food consumption among beneficiaries (Martins et al., 2013).
The mixed conclusions on CCTs effects on health and nutrition were clear manifestations
of the differences in context, policy making, and policy implementation between nations.
CCT programs were most effective in improving the health and nutrition situation when
governments have strong and sustained political support, adequate monetary funding,
and transparent policies (Segura-Perez et al., 2016). Moreover, this can also be a case
of flawed account in material realities in a country. Tabuga and Reyes (2012) pointed out
that some CCTs failed to acknowledge that the poor is not all the same, thus, failing to
target chronic poor populations.
The Pantawid Pamilyang Pilipino Program (4Ps)
The Philippines is one of the few countries to adapt a CCT program to combat hunger
and poverty in the country. In 2007, in the midst of a social sector reform, the Department
of Social Welfare and Development started a pilot program in Pantawid Pamilya
(Fernandez & Olfindo, 2011). The program was initially targeting 20,000 beneficiaries,
but, then president, Gloria Macapagal-Arroyo scaled it up to 300,000 beneficiaries
because of the increased poverty and dropout rates during the time (Raquiza, 2013).
Since then, the program has continuously expanded and has reached one million
beneficiaries in 2011 (Fernandez & Olfindo, 2011). In 2016, the program has reached
4.4 million Filipinos, catering to about 20% of the country’s population (World Bank, 2017).
Currently, 4Ps has been serving all 17 regions in the country and its 79 provinces, 143,
cities, and 1,484 municipalities (Official Gazette of the Republic of the Philippines, 2015).
In 2019, President Rodrigo Duterte have finally made the Pantawid Pamilyang Pilipino
Program as the nation’s poverty reduction strategy by signing the R.A. 11310
(Department of Social Welfare and Development, 2019).
The Pantawid Pamilyang Pilipino Program was regarded to be the government’s flagship
poverty alleviation program. Pangcoga (2011) described it to be a conditional cash
transfer program that targets the country’s poorest of the poor. More than poverty
alleviation, 4Ps was developed to address specific Millennium Development Goals:
reduction of poverty and hunger, universal quality education, gender equality, reduction
of child mortality, and improvement on maternal health (Pablo et al., 2009). The program
aimed to provide social assistance and social development for the countries most
marginalized populations (Official Gazette of the Republic of the Philippines, 2015).
In the nature of a CCT, the 4Ps has it own set of conditionalities that beneficiaries should
meet. There were conditionalities under two grant types of 4Ps, one is health grant
conditionalities, and the education grant conditionalities (Fernandez & Olfindo, 2011).
Health and nutrition conditions were comprised of health monitoring conditions, such as,
constant visit to health centers to avail health services, deworming twice a year, at least
one pre-natal checkup in a trimester (for pregnant women), and attendance to a family
development session at least once a month. Education condition, on the other hand,
require beneficiaries to retain an 85% class attendance every month (Department of
Social Welfare and Development, 2018). The 4Ps manual stated that compliant
beneficiary households shall receive a monthly health grant of PHP 500 and education
grant of PHP 300 for a pre-school and elementary children, and PHP 500 for high school
children (Department of Social Welfare and Development, 2018).
Impact of the Pantawid Pamilyang Pilipino Program on Health and Nutrition
Compared to the general consensus of the impacts of CCTs on health and nutrition
worldwide, the Philippines have yield relatively positive results through the Pantawid
Pamilyang Pilipino Program. Kandpal et al. (2016) said that the program was evidenced
to have promising impacts on child nutrition, paving the way to its further expansion. In
fact, 4Ps improved growth among infants, and children from five years old below showed
better food consumption (Tabilog et al., 2017). In the evaluation made by Frufonga (2015)
on 4Ps in Iloilo evidence of 4Ps success on improving children’s nutrition manifested. In
Pangasinan, two barangays (Brgy. Bical Norte and Bani) excellent malnutrition prevention
have been evident and has seen an improvement on beneficiary households’ healthseeking habits (Fernandez & Pambid, 2017). Moreover, evidence suggest that 4Ps has
aided in the improvement of maternal health (Frufonga, 2015).
In terms of food security, and diet, 4Ps has deemed to be of help to its beneficiaries.
Findings from Montilla et al. (2015) found 72% of the respondents from an elementary
school in Masbate spent at least PHP 200 on their meals that covers for three meals.
Furthermore, beneficiary households were found to allot the cash transfers they received
from 4Ps for health and nutrition, and education of children (Virgilla-Montecillo et al.,
2015). This was an indication that beneficiaries respond to these cash transfer rationally
by prioritizing social needs such as, health and education (Orbeta & Paqueo, 2016).
Virgilla-Montecillo et al. (2017) showed evidence suggesting that beneficiary households
have better economic access to food, thus, were less food insecure. Cash transfers can
directly improve the quality and diversity of diet through increased household income
(Virgilla-Montecillo et al., 2017).
Amidst various promising results, there were still shortcomings in the outcomes of the
program. There was no apparent improvement on nutrition outcomes (underweight,
stunting, and wasting) among children of 4Ps beneficiary households (Raquiza, 2018). In
its early stage, 4Ps exhibited strong results on nutrition but recently has been inconclusive
(Cho et al., 2020). This could have been a result of the scarcity of community health
workers that will cater to monitoring and compliance of health outcomes among the
growing number of beneficiaries (Peñalba, 2019). Moreover, the program has failed to do
the essential determination of a household’s poverty status, by differentiating transient
poor households from chronic poor households (Tabuga & Reyes, 2012; Peñalba, 2019).