162717 Institutional issues in designing a conditional cash transfer program to facilitate access to health care and education in Haiti

Wednesday, November 7, 2007: 9:30 AM

Marc J. Cohen, PhD , Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC
Marie T. Ruel, PhD , Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC
Purnima Menon, PhD , Program in International Nutrition, Cornell University, Ithaca, NY
Doris Wiesmann, PhD , Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC
Natalia Smith, MPH , Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC
Several countries in Latin America have successfully implemented conditional cash transfers (CCTs), which provide money to poor families conditional upon investments in human capital such as use of health and education services. CCTs have improved health and reduced poverty, but are administratively demanding and require strong health and education infrastructure.

Our objective was to assess the feasibility of implementing a CCT in Haiti, which is the poorest country in the Western Hemisphere. Years of internal conflicts and climatic shocks have devastated the economy, depleted human capital, and weakened state capacity.

We used qualitative methods (key informant and focus group interviews) and secondary data analysis to examine the costs of schooling and health care, barriers to use of services, and potential institutional arrangements to address the programmatic demands of a CCT. These include identifying an institution capable of coordinating across ministerial lines, operating transparently, and administering complex procedures. Other issues include the capacity to: *Effectively target benefits to the poor and deliver payments; *Monitor compliance with conditions; *Ensure adequate supply of services; *Establish appeals mechanisms; *Consider multiple stakeholder needs and perspectives in the program design.

In such a setting, our findings suggest that a combination of governmental and non-governmental institutions, with clearly defined functions for each institution, is most likely to address the overall programmatic demands of a CCT. The high demand for schooling and for health care in Haiti suggests that a CCT, if organized and administered well, could significantly improve lives in Haiti.

Learning Objectives:
1. Discuss the lack of access to health services among low-income rural Haitians. 2. Describe how a conditional cash transfer program can facilitate poor families' investment in the human capital of their children, including regular visits to preventive health care facilities. 3. Articulate the institutional issues involved in implementing a conditional cash transfer program in Haiti.

Keywords: International Public Health, Poverty

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.