Cash transfers directed to female caregivers in Nicaragua led to gains in child-development outcomes that persisted beyond the duration of the program.
Early childhood is a critical period for investment in human development, the circumstances of which can have lifelong impacts. Physical, cognitive, or behavioral delays in development can result in long-term negative effects on health, educational attainment, labor-market outcomes, and other indicators of well-being.
Conditional cash transfer (cct) programs are one way to help parents who lack resources invest more in their children. These programs provide families with cash grants as long as they undertake certain activities such as having their children attend regular health check-ups. While there is a large body of evidence on the short-term impacts of ccts on children’s development, there is less evidence on their long-term impacts. To better understand the effects of ccts later in life, researchers evaluated two distinct cct programs in Nicaragua.
In the first evaluation, researchers Tania Barham (University of Colorado Boulder), J-PAL affiliate Karen Macours (Paris School of Economics), and John A. Maluccio (Middlebury College), examined the long-term impacts of ccts on child development. In this study, they tested whether there is a critical window of time (the first 1,000 days from in utero to age two) for cognitive and physical development by taking advantage of the random assignment of households to receive cash transfers in either an “early” or “late" treatment group. In the second evaluation, Karen Macours, Norbert Schady (Inter-American Development Bank), and Renos Vakis (World Bank) studied a cct program with three variations to understand the channels through which different program components impacted early childhood development.
We use detailed contract level data on a portfolio of 197 coffee washing stations in 18 countries to identify the sources and consequences of credit markets imperfections. Due to moral hazard, default rates increase following unanticipated increases in world coffee prices just before (but not just after) the maturity date of the contract. Strategic default is deterred by relationships with the lender and foreign buyers: the value of informal enforcement amounts to 50% of the value of the sale contract for repaying borrowers. A RDD shows that firms are credit constrained. Additional loans are used to increase input purchases from farmers rather than substituting other sources of credit. Prices paid to farmers increase implying the existence of contractual externalities along the supply chain.
This article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take-up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out-of-pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health-care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program.