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Old and new welfare: their relative effect on child nutrition

Old and new welfare: their relative effect on child nutrition. Julieta Trias. (joint with Orazio Attanasio – Marcos Vera-Hernandez) FAO – Chile, December 1 2008. Interventions.

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Old and new welfare: their relative effect on child nutrition

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  1. Old and newwelfare: their relative effect on child nutrition JulietaTrias (joint with Orazio Attanasio – Marcos Vera-Hernandez) FAO – Chile, December 1 2008

  2. Interventions • Interventions that can potentially improve nutrition: a) conditional cash transfers (CCT), b)unconditional cash transfers, c) price subsidies, d)distribution of nutritional supplements, and e) childcare centres where children are fed and taken care. • CCT programs have become very popular tools for governments to relieve poverty and increase human capital accumulation. There is a consensus that they are effective tools at increasing the uptake of preventive care (Lagarde 2007) but there is also controversy about their effect on nutritional status. • For instance, PROGRESA increased the height of children under 36 months by 1 cm (Behrman and Hoddinott 2005, Gertler 2004, and Rivera et al 2004). Honduran CCT programme was not found to achieve any improvement in nutritional status (IFPRI 2003).

  3. Objective • The objective of the paper is to compare the relative merits of CCT programs with more traditional programs to improve children nutritional status. • As far as we know, there has been no research comparing these type of programs. • We will compare the effect of Familias en Acción, a CCT program with the effect of HogaresComunitarios, a childcare and feeding program in Colombia on nutritional outcomes (HAZ, WAZ, WHZ, chronic, global and acute malnutrition and risk of malnutrition) and morbidity outcomes (diarrhea (EDA) and acute respiratory infection (ARI) ).

  4. “HogaresComunitarios” Nutrition and childcare program introduced all over Colombia in the mid 1980s. The program is targeted to poor children between 0-6 years old. Parents are required to pay a monthly fee about $US 4 per month per child, although there is considerable variation in the amount across towns. Children attending to the nurseries receive a lunch and two snacks that include a nutritional beverage called bienestarina. Children attending to HC should receive the 70% of recommended daily intake.

  5. “Familias en Acción” • Large-scale welfare program introduced in 2001. In 2002, the program registered 365,000 and currently involves more than 1.5 million households. • The program gives a monetary transfer to mothers provided their children are up to date with growth and development monitoring visits and attend school regularly. • Nutritional subsidy: $CO 46,500 (U$20) monthly per family with children under 7. Primary School ($CO 14,000 ($US 5) pcm) and Secondary School ($CO 28,000 ($10 pcm)). • Eligibility. Families with children under 18 classified as being in the lowest level of the official socio-economic classification (Sisben level 1). • No nutritional supplementation. Program perceived as an alternative to HC for families with children 0-6.

  6. Other issues: • FA operates by transferring money to the mother (unclear how much of this transfer ends up benefiting the child). HC should provide food directly to the child while the child is in the HC centre. • FA program is relatively easy to expand to other households or municipalities but HC requires setting up the logistic of food purchase, providing training to the child carers, monitoring to prevent the food from being resold or used by individuals different from the children for whom it is intended, as well as to have adequate premises for the children.

  7. Outline Data Basic Statistics Methodology Results Summary & concluding remarks

  8. Data - Colombia • Survey collected to evaluate FA program + administrative data • First Wave: 2002. Collected in 122 communities, 57 are targeted by FA. (9.080 children 0-6 / 3.940 households) • Second Wave: 2003 (8.880 children 0-6 / 2.760 households) • Third Wave: 2005/2006 (not used) • FA surveyalso collected data on the participation of the children on HCas well as on variables that are important determinants of the participation in HC. • Information: socio-demographic characteristics, anthropometric variables, distances to important places in the town such as nearest health centre and school, distance from the household to the nearest HC centre, current and retrospective information on participation in the HC program.

  9. Basic Statistics Payments Distribution Familias en Accion - 2003

  10. Yihmt: nutritional status of child iof household h, living in municipality m, in year t. EFAiht: nutritional subsidy per child in household h until time t (or exposure for child i at until t) EHCiht: months in HC for child i until time t (or exposure for child i until t) Xiht:contains variables that are specific to child i and household h including a dummy whether or not household h has a child eligible for the FA program. Tt: dummy variable for each wave θm: municipality fixed effects Empirical Specification yihmt= βFA (EFA)ihmt+βHC(EHC)ihmt+ βXXiht +βTTimet+θm+εihmt Problem: EFA and EHC are endogenous variables Strategy: IV approach with municipality FE Identification: βFA relies on the availability of the program. βHC relies on some households living closer to a HC centre than others (Attanasio and Vera-Hernandez (2006)).

  11. Treatments and Instruments • Treatments: • FA: accumulated conditional payments per child and life exposure (#months FA/ child’s age), exposure scaled #children (#months FA/children under 17) • HC: # months child ever attended and life exposure. • Instruments: • FA: potential conditional payments per child, potential life exposure and potential exposure. Treatment in the municipality • HC: distance to the nearest HC (controls for other distance) • Non linear prediction of months in HC (PHC). Interaction between PHC with FA treatment in the municipality.

  12. Controls • Child characteristics: age, birth order, gender. (inverse of age) • Mother’s characteristics: age, education, height, marital status (single) • Household characteristics: • Children under 7 in the household potentially eligible for FA (0 or 1 for controls and treatment) • # children 8-12, # children 13-17 • household head’s age and education. • Location: area, travel time to health center, school and town center.

  13. Results – First Stage Distance to HC: 30 min. of extra travel to the HC increases the subsidy per child by $CO 1,232 and reduces the time attending a HC by 9.8 days (21.6 days considering distance at each wave). FA program(treatment + 1 year pot. subsidy): reduces the attendance to HC in 6.1 months for children at the average age (48 months) and increases the transfer in $CO 502,000. Households with schooling age child: An additional sibling in secondary school age increases the nutritional subsidy by $CO 2000 per child and reduces the attendance to HC by 6.2 days. Single Mothers: increases child’s attendance to HC by 28 days and reduces the transfer per child by $CO 2,000. Distance to health facilities: 30 min. of extra travel reduces the transfer by $CO 234 per child and increases the attendance to HC by 3.4 days. However, those effects are not significant.

  14. One year program effect

  15. HAZ: one year in FA program for a child with 3 siblings under 17, increases the z-score by 0.09, reduces prevalence of chronic malnutrition (cn) by 1% and the risk cn by 4%. For the case of HC the effect is 0.12, -4% and -5%, respectively. • F-Test equal effect FA and HC: no rejection. • WAZ: FA increase z-score by 0.14 and reduce the probability of global malnutrition by 3% while for HC is 0.06 sd and 1%, respectively. • EDA: reduction in about 3% in both programs • IRA: reduction in 4% for FA and 5% for HC.

  16. Summary and Conclusions Both programs improve the nutritional status and morbidity outcomes of children under 7 and there is not significant difference in their impact. This result is consistent with previous studies where FA program improves the quality of the food consumed. It also complements studies of the effectiveness of HC. This result doesn’t imply that the programs are substitutes. Different groups of the population may prefer different programs. Our estimates provide some insight about the characteristics that are relevant in the choice of FA vs HC –for instance, single mothers prefer HC program. Further research on the potential complementarities of both programs should be carried out.

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