Publication: Tanzania: Can Conditional Cash Transfers Encourage Safer Sexual Behavior?
Loading...
Date
2015-01
ISSN
Published
2015-01
Author(s)
Editor(s)
Abstract
Conditional cash transfer programs are often used to encourage poor families to take young children for regular health check-ups and enroll them in school decision making. Can cash transfers successfully cut transmission of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) by reducing risky sexual behaviors? How can these programs be structured for maximum impact to help countries meet the challenges of reducing HIV and AIDS and other sexually transmitted diseases? The World Bank is working with the international community and governments to stop the spread of HIV and AIDS. The extraordinarily high social and economic cost of the HIV and AIDS crisis requires that governments and development experts continue the search for innovative and effective prevention approaches, including financial incentives. The results of the evaluation indicate the potential of financial incentives for reducing the spread of sexually transmitted infections and possibly as a route for HIV prevention.
Link to Data Set
Citation
“World Bank. 2015. Tanzania: Can Conditional Cash Transfers Encourage Safer Sexual Behavior?. From Evidence to Policy;. © World Bank. http://hdl.handle.net/10986/22632 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication Kenya(Washington, DC, 2022-10)Before the COVID pandemic, more than half of children in low and middle-income countries suffered from learning poverty: they either were out of school or failed to learn to read with comprehension by age 10. At the same time, numerous studies have documented serious challenges related to the quality of education services, particularly for those serving poor students. In a country like Kenya, for example, teachers exhibit low levels of content and pedagogical knowledge. Previous research has shown that highly structured teaching guides could improve literacy, but scripted lessons are not without critics, who worry that teachers will not be able to adapt content to student’s needs. In places where teachers may be less prepared to tailor high quality lessons to their students, however, scripting may offer a way to standardize a minimum level of quality at scale.Publication Rwanda(World Bank, Washington, DC, 2021-11)Children need a safe, nurturing, healthy, and stimulating environment to thrive and reach their full potential. But millions of children living in poverty don’t receive enough stimulation or good nutrition in their first years of life, and poverty also makes them more likely to experience neglect and violence in the home. Domestic violence, however, is rarely addressed in programs promoting young children’s development, which also typically focus on mothers, with little attention on fathers. Previous research suggests home-based parenting programs can lead to positive improvements in children’s brain development. Can these programs be adapted to address family violence as well Can these services be effectively delivered through government social safety net programs which often target poor, vulnerable familiesPublication India(World Bank, Washington, DC, 2021-07)In the first years of life, all children need healthy food, a clean environment, and stimulation to thrive and reach their full developmental potential. However, poverty prevents millions of young children in low- and middle-income countries from receiving adequate nutrition and stimulation. As a result, many disadvantaged children’s brain development lags behind that of their well-off peers, which can have lifelong consequences. Previous research from low-income settings has found that encouraging parents to play and interact more with their children can improve children’s brain development, with impacts that can last into adulthood. Delivering these parenting programs at scale and in a cost-effective manner, however, has been a challenge, in part because some of the most successful programs have been delivered through intensive and relatively costly home-based programs.Publication Armenia(World Bank, Washington, DC, 2021-04)More people around the world are dying from noncommunicable diseases than ever before. These diseases, which include cancer, chronic respiratory diseases, diabetes, and heart disease, prematurely kill more than 15 million people between ages 30 and 69 each year. Many of these health conditions also make individuals more susceptible to severe forms of other diseases like Coronavirus disease 2019 (COVID-19). This study targeted adults between the ages of 35 and 68 in Armenia who had not been screened in the preceding year. The baseline data suggests this population was not economically secure: half of participants responded that their income was sufficient for basic family needs, such as food, clothing, and utilities, but not enough for big purchases like a car, while 35 percent responded that their income is sufficient for everyday food but not for clothes and other basic needs. More than half of those in the study were unemployed. This research finds that conditional incentives and personalized invitations can substantially increase screening for diabetes and hypertension for those who haven’t been recently screened. Further research may be needed to evaluate these interventions at scale.Publication Philippines(World Bank, Washington, DC, 2020-11)The World Bank’s Strategic Impact Evaluation Fund supported a randomized controlled trial from 2015-2018 to assess the extent to which subsidized microloans can enable households to build and use improved toilets. The loans, which carried zero interest, included toilet installation and were offered to poor beneficiaries who also received sanitation behavior change promotion as part of a social safety net program. The large financial subsidy led to modestly higher coverage of improved toilets, better toilet quality, and greater satisfaction, while the small subsidy did not improve access to improved sanitation. Among those who took out the subsidized loans, 59 percent already had improved toilets, which explains the limited effects on improved sanitation and open defecation. Overall, these findings suggest that subsidy programs hold promise, but need to be better targeted.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Rewarding Safer Sex : Conditional Cash Transfers for HIV/STI Prevention(World Bank Group, Washington, DC, 2014-11)Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania. The intervention arm received conditional cash transfers that depended on negative results of periodic screenings for sexually transmitted infections, an objectively measured marker for risky sexual behavior. The intervention arm was further divided into two subgroups, one receiving a high value payment of up to $60 over the course of the study ($20 payments every four months) and the other receiving a lower value payment of up to $30 ($10 payments every four months). At the end of the one year of intervention, the results showed a significant reduction in sexually transmitted infections in the group that was eligible for the $20 payments every four months, but no such reduction was found for the group receiving the $10 payments. The effects were stronger among the lower socioeconomic and higher risks groups. The results of a post-intervention follow-up survey conducted one year after discontinuing the intervention indicate a sustained effect among males, but not among females.Publication The Heterogeneous Effects of HIV Testing(World Bank, Washington, DC, 2014-03)An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures, or both. This study investigates the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. The study finds no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, among the small group of individuals who tested positive for HIV, a large increase in the probability of contracting HSV-2 is found, with this effect stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results see a significant improvement in achievement test scores, consistent with increased returns to investments in human capital. The finding of increased HSV-2 prevalence among HIV-positive individuals suggests that the conventional wisdom that those who learn they are HIV-positive will adopt safer sexual practices should be treated with caution.Publication West Africa HIV/AIDS Epidemiology and Response Synthesis : Implications for Prevention(Washington, DC, 2008-11)This synthesis paper describes the HIV epidemics in 15 West African countries - Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone. It focuses particularly on the degree to which the epidemics in each country are concentrated or generalized, and the implications for effective prevention. The urgent need for rigorous analytic work to equip countries with a sound, situation-specific analytical base for action motivated this study. The analysis team critically reviewed and interpreted all available surveillance, survey and research data (the amount and quality of which varied considerably by country). For the first ten countries listed, short country visits enabled interviews and more thorough search for data and other information, and the programmatic response to the HIV/AIDS epidemic was also assessed to develop recommendations for improving resource allocation and program effectiveness.Publication 20 Years of HIV in Bangladesh(World Bank, Washington, DC, 2009-12)This report synthesizes data from surveillance, behavioral surveys and published and unpublished research to better understand emerging patterns and trends in the HIV epidemic in Bangladesh. Taking stock of 20 years of experience with HIV in Bangladesh, this report summarizes what is known about the coverage and impact of HIV prevention services, including knowledge on risk and protective behaviors. The report is divided into nine chapters. Chapter one provides a brief introduction and an overview of the methodology used for this exercise. Chapter two discusses the risks and vulnerabilities of the high risk groups including female sex workers, injecting drug users, male who have sex with male, hijra and overlapping populations, while chapter three discusses the trend of the infection amongst partners of high risk groups. Bangladesh continues to report low condom use, which is analyzed and discussed in chapter four. Structural factors including macro level and intermediate level factors that affect HIV interventions in Bangladesh are addressed in chapter five. The national HIV response is discussed in chapter six. The report concludes with a discussion of the main findings, with recommendations for the future in chapter seven, and chapter eight and nine are annexes and references.Publication Stimulating Demand for AIDS Prevention : Lessons from the RESPECT Trial(2012-02-01)HIV-prevention strategies have yielded only limited success so far in slowing down the AIDS epidemic. This paper examines novel intervention strategies that use incentives to discourage risky sexual behaviors. Widely-adopted conditional cash transfer programs that offer payments conditioning on easily monitored behaviors, such as well-child health care visits, have shown positive impact on health outcomes. Similarly, contingency management approaches have successfully used outcome-based rewards to encourage behaviors that are not easily monitored, such as stopping drug abuse. These strategies have not been used in the sexual domain, so this paper assesses how incentives can be used to reduce risky sexual behavior. After discussing theoretical pathways, it discusses the use of sexual-behavior incentives in the Tanzanian RESPECT trial. There, participants who tested negative for sexually transmitted infections are eligible for outcome-based cash rewards. The trial was well-received in the communities, with high enrollment rates and more than 90 percent of participants viewing the incentives favorably. After one year, 57 percent of enrollees in the "low-value" reward arm stated that the cash rewards "very much" motivated sexual behavioral change, rising to 79 percent in the "high-value" reward arm. Despite its controversial nature, the authors argue for further testing of such incentive-based approaches to encouraging reductions in risky sexual behavior.
Users also downloaded
Showing related downloaded files
Publication Remarks at the United Nations Biodiversity Conference(World Bank, Washington, DC, 2021-10-12)World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.Publication Making Procurement Work Better – An Evaluation of the World Bank’s Procurement System(Washington, DC: World Bank, 2024-12-06)This evaluation assesses the results, successes, and challenges of the World Bank 2016 procurement reform. Procurements acquire the works, goods, and services necessary to achieve the World Bank’s project development outcomes. The World Bank’s procurement processes must ensure that clients get the best value for every development dollar. In 2016, the World Bank reformed its procurement system for Investment Project Financing and launched a new procurement framework aimed at enhancing the Bank’s development effectiveness through better procurement. The reform sought to reduce procurement bottlenecks impeding project performance and modernize procurement systems. It emphasized cutting edge international good practice principles and was intended to be accompanied by procurement capacity strengthening to help client countries. This evaluation offers three recommendations to scale up reform implementation and enhance portfolio and project performance: (i) Improve change management support for the reform’s implementation. (ii) Strategically strengthen country-level procurement capacity. (iii) Consistently manage the full spectrum of procurement risks to maximize project success.Publication Economic Recovery(World Bank, Washington, DC, 2021-04-06)World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.Publication South Asia Development Update, April 2024: Jobs for Resilience(Washington, DC: World Bank, 2024-04-02)South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.Publication Media and Messages for Nutrition and Health(World Bank, Washington, DC, 2020-06)The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.