Performance-Based Incentives for Health: Conditional Cash Transfer Programs in Latin America and the Caribbean

60 Pages Posted: 30 Jul 2007

See all articles by Amanda Glassman

Amanda Glassman

Brookings Institution

Jessica Erin Todd

U.S. Department of Agriculture (USDA) - Economic Research Service (ERS)

Marie Gaarder

Inter-American Development Bank (IDB); World Bank

Date Written: April 23, 2007


In order to support poor families in the developing world to seek and use health care, a multi-pronged strategy is needed on both the supply and the demand side of health care. A demand-side program called Conditional Cash Transfers (CCTs) strives to reduce poverty and also increase food consumption, school attendance, and use of preventive health care. Since 1997, seven countries in Latin America have implemented and evaluated CCT programs with health and nutrition components. The core of the program is based on encouraging poor mothers to seek preventive health services and attend health education talks by providing a cash incentive for their healthy behavior (with healthy behavior representing performance). Evaluations of these programs measured outputs in the utilization of services; health knowledge, attitudes, and practice; food consumption; the supply and quality of services; as well as outcomes in vaccination rates; nutritional status; morbidity; mortality; and fertility.

While CCT impact evaluations provided unambiguous evidence that financial incentives increase utilization of key services by the poor, the studies gave little attention to the impact on health-related behaviors, attitudes, and household decision-making or how these factors contribute to or limit impact on health outcomes. Recommendations include expanding the scope of future evaluations to study these effects, modeling program effects beforehand, and carefully selecting the conditions for payment so that they are not too burdensome yet not irrelevant. Continuing to focus on the extreme poor is recommended since findings show that the poorest households must reach a minimum level of food consumption before they are able to make other investments in their health and well-being.

Keywords: Health, Latin America, Caribbean, Financial Services

Suggested Citation

Glassman, Amanda and Todd, Jessica Erin and Gaarder, Marie, Performance-Based Incentives for Health: Conditional Cash Transfer Programs in Latin America and the Caribbean (April 23, 2007). Center for Global Development Working Paper No. 120, Available at SSRN: or

Amanda Glassman

Brookings Institution

1775 Massachusetts Ave, NW
Washington, DC 20036
United States

Jessica Erin Todd (Contact Author)

U.S. Department of Agriculture (USDA) - Economic Research Service (ERS) ( email )

355 E Street, SW
Washington, DC 20024-3221
United States
(202) 694-5363 (Phone)

Marie Gaarder

Inter-American Development Bank (IDB)

1300 New York Avenue NW
Washington, DC 20577
United States

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

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