from EVIDENCE to POLICY THEWa BANK Learning what works for better programs and policies July, 2014 Philippines: Are Cash Transfer Programs Effective? Countries around the world increasingly rely on con- The World Bank is committed to working with ditional cash transfers to boost health and education countries to reduce extreme poverty and boost shared outcomes for their poorest citizens. In Latin America, prosperity. To succeed, development experts and pol- where these programs were pioneered, conditional icymakers need to know what programs are effective cash transfers are now the basis of large-scale gov- and which ones aren't delivering. In the Philippines, ernment initiatives the World Bank teamed up with the Government of to help the most the Philippines in 2007 to develop the Pantawid Pam- vulnerable. In devel- ilyang Pilipino Program, a conditional cash transfer oping and middle- program for the poor. An impact evaluation was built income countries in into the program to measure the effect. The evalua- Asia, Africa and the tion found that Pantawid Pamilya reduced stunting Middle East, cash among young children, increased family spending on transfer programs are health and education, and raised student enrollment proving effective in and attendance. But the results also pointed to an a range of areas, in- important shortcoming-children aged 12 and above cluding as an incen- weret more likely to enroll in school. Based on the tive to get more girls in school. As their popularity evidence, the Government of the Philippines has has grown, policymakers are starting to question how increased the cash transfer amount for older stu- these programs can be adapted to reach more people dents and expanded the program to include chil- and further improve lives. dren ages 15-18, who were not previously covered. Despite a significant degree of economic growth over remained largely stagnant. An estimated 23 million the past decade, the poverty rate in the Philippines has Filipinos-a quarter of the country's population-re- main poor. This is in stark contrast to the other coun- Did You Know? In the Philippines... tries in the region, which have seen their poverty rates * Some 40 percent of children ages 12-15 years old are not in school decline considerably as their economies have grown. * Just 70 percent of infants are fully immunized The Philippines is also unlikely to reach the Millenni- i Only 30 percent of children attend day care programs or preschools um Development Goal targets relating to universal pri- SMore than a quarter of children age 0-5 are underweightlt SFor the poorest Filipinos, only 25 percent of births are attended oa mea e cte eal by a trained assistant, with just 13 percent taking place in a The Pantawid Pamilya cash transfer program was health facility developed to encourage and help the countrys poor- (UNICEF) est families invest in their children's future. It's become cornerstone of the country's social protection agenda from Pantawid Pamilya are relatively modest: Households and by March 2014, covered approximately four million can receive a maximum of $32 per month. On average, poor households with children up to the age of 14- households received about 800 pesos per month (about about 93 percent of the target population. Households $18.50) or about 13 percent of their monthly income. receive 500 pesos (about $11.50) a month for meeting The program targets poor households that live in geo- basic health conditions, including regular check-ups for graphic areas identified because of their high poverty rates. pregnant women and children under the age of five, and Families living in these areas are selected for the program in-school deworming for children between the ages of six based on a proxy means test, which measures a familys and 14. One or both parents also must attend a monthly well-being based on things like housing quality, house- Family Development Session, where they discuss a variety hold goods and education. Only households that are of topics from parenting and family relations to disaster timated to have per capita income below the provincial risk and stress management. Households also qualify for poverty level and have children younger than age 14 and! 300 pesos ($6.70) a month (for 10 months a year) for or pregnant women can enroll. Once enrolled, schools each child between the ages of six and 14 who is enrolled and health facilities where beneficiaries receive services are in school and attends at least 85 percent of the time. The responsible for reporting on whether families have met the grants for education are capped at three children. Payouts conditions for receiving their monthly payment. The program evaluation was designed to include a ran- randomly chosen in eight randomly selected municipali- ________ domized impact evaluation so the government could mea- ties. This included 1,418 qualifying households and the sure the effect and make changes accordingly. Research- remainder non-qualifying households, either because they ers relied on the programs phased roll-out-necessitated didn't have young children or a pregnant mother or be- because there wasn't enough money or administrative ca- cause they weren't poor. All the villages in these eight mu- pability to immediately offer it to everyone who would nicipalities were randomized into treatment and control qualify-to create a control group among areas slated to groups in 2008 and the program was launched in 2009. receive the program at a later date. The follow-up surveys were conducted in 2011, giving the In the first phase, the program targeted about 376,000 treatment households more than two years of exposure to households in 148 municipalities and 12 cities in 34 prov- the program, enough time to see impacts. A second survey inces. For the impact evaluation, 3,742 households were is underway and results are expected shortly. imtdit aepegaiasnoebeo hpoica Preschool and primary school age children program, where the enrollment rate was 65 percent. El- whose families lived in areas where the cash ementary school enrollment increased by 4.5 percentage transfer program was available were more points, a rate that pushes the country into near universal likely to be in school. primary school enrollment. Attendance for elementary Enrollment in preschool rose 10.3 percentage point, com- school-age children, aged six to 11, rose 3.8 percentage pared with poor children in districts that d at receive the points from a baseline of 91 percent. Older children weren't affected the same way: children in areas that didn't get the program. These health Attendance rose, but enrollment stayed the gains are expected to have important long-term benefits, same, limiting the impact. because stunting in the first two years of life harms brain Among children between the ages of 12 and 14 and al- development, reducing a child's ability to do well in ready enrolled in school, attendance rose by 4.9 percent- school and later in life. age points. In other words, more than 95 percent of these Parents in the program spent 38 percent more on pro- children attended school regularly, compared with about tein-rich foods like eggs and fish for their children and they 90 percent of the same-aged children in families who didn't learned about nutrition in the monthly Family Develop- receive the program. This improvement in attendance, ment Sessions. They also were more likely to bring children however, was among students already in school. The pro- up to the age of five for regular health check-ups. Growth gram didn't show any impact on enrollment, which stayed monitoring rose by 15 percentage points (compared with a around 85 percent for children in both groups. baseline of 17 percent), while the use of Vitamin A supple- A similar impact was seen among children between the ments rose by 6.2 percentage points. Older children, too, ages of 15 and 17. Although the cash transfer wasn't con- saw a positive impact from the program. Children aged ditional on improved schooling for these older children, 6-14 were more likely to have taken at least one of the two there was a 7.6 percentage point increase in school atten- deworming pills offered every year in schools, an increase dance among children aged 15 to 17 living in areas where of 9 percentage points over the 80 percent rate for children the program was offered. Researchers suspect that the em- in areas without the program. phasis on education for the younger ages had a spill-over ef- fect on older children already in school. But overall enroll- Pregnant women and mothers who received ment didn't move from around 62 percent of the children the cash transfers were more likely to get four in this age group. prenatal check-ups and care right after giving birth. I - Families may have decided the cash transfer Poor mothers improved their use of prenatal care by 10.5 wasn't enough to offset the costs of sending percentage points, up from just over 50 percent of poor older children to school, especially because women living in areas where the program wasfA available. they could go to work instead. They were also 10 percentage points more likely to see care Families were receiving 300 pesos ($6.50) for each rightaftergivingbirth, up from justover 60 percentofwom- child in school, regardless of the age and limited to en who didt get the program. cover a maximum of three children. But this mon- ey doesn't cover the full costs of sending a child to Still, the program didn't boost the likelihood that a school, including clothes, books and food, which woman would give birth in a health center or with rises with older children. Sending older students to assistance of a trained health worker. There was school is therefore expensive-both in terms of actual also no improvement in the health of new mothers costs and lost earnings. or their babies. The Philippines has made little progress in the past The program had a big impact on reducing severe decade in reducing maternal mortality rates and each stunting and improving the health of young year there are some 100 deaths for every 100,000 live children. Gains were also seen for older children. births, a rate the country has been trying to cut in half as Severe stunting for very young children-ages six months part of its Millennium Development Goals. The rate of to three years old-was reduced by 10 percentage points, night blindness among pregnant women-believed to compared with a severe stunting rate of 24 percent for be linked to a Vitamin A deficiency-also stayed around This policy note is based on the report "Philippines Conditional Cash Transfer Program: Impact Evaluation 2012," January 2013 https://openknowledge.worldbank.org/handle/1 0986/13244 11 percent for women regardless of whether or not they also found that women receiving the transfers were not received the program. having more children than women in the control group. Although people received extra money, there Overall, the program caused people to spend was no decline in hours spent working. Nor did it more on things that matter: education and health. lead women to have more children. Parents receiving the cash payments spent 38 percent more Even with the additional income, there was no evidence that per capita on education and 34 percent more on medical people in the beneficiary households worked fewer hours or expenses, compared with poor families who didn't receive made less of an effort to find employment. The study the program. And spending on alcohol declined. Conclusion Conditional cash transfers are keeping poor children attempt to raise secondary school enrollment and at- healthy and in school all over the world. But can they tendance. As policy makers and development experts be made even more effective and reach even more peo- continue to search for innovative ways to help the ple? In the Philippines, the results of an evaluation of world's poor, the findings from this evaluation will the Pantawid Pamilya program led the government to provide much-needed evidence for designing increas- extend cash transfer eligibility to older children in an ingly effective programs. The Strategic Impact Evaluation Fund, part of the World Bank Group, supports and disseminates research evaluating the impact of development projects to help alleviate poverty. The goal is to collect and build empirical evidence that can help governments and development organizations design and implement the most appropriate and effective policies for better educational, health and job opportunities for people in developing countries. For more information about who we are and what we do, go to: http://www.worldbank.org/sief. The Evidence to Policy note series is produced by SIEF with generous support from the British government's Department for International Development. THE WORLD BANK THE WORLD BANK, STRATEGIC IMPACT EVALUATION FUND 1818 H STREET, NW WASHINGTON, DC 20433 Produced by the Strategic Impact Evaluation Fund Series Editor: Aliza Marcus; Writer: Daphna Berman