Cash Transfers and Health: Evidence from Tanzania
In: World Bank Policy Research Working Paper No. 7882
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In: World Bank Policy Research Working Paper No. 7882
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Working paper
In: World development: the multi-disciplinary international journal devoted to the study and promotion of world development, Band 114, S. 138-155
World Affairs Online
PR ; IFPRI3; ISI; CRP2; Capacity Strengthening; E Building Resilience; F Strengthening institutions and governance ; DSGD; PIM ; CGIAR Research Program on Policies, Institutions, and Markets (PIM)
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How does a locally-managed conditional cash transfer program impact trust in government? On the one hand, delivering monetary benefits and increasing interactions with government officials (elected and appointed) may increase trust. On the other hand, it can be difficult for citizens to know to whom to attribute a program and reward with greater trust. Further, imposing paternalistic conditions and possibly prompting citizens to experience feelings of social stigma or guilt, could reduce trust. We answer this question by exploiting the randomized introduction of a locally-managed transfer program in Tanzania in 2010. Our analysis reveals that cash transfers can significantly increase trust in leaders. This effect is driven by large increases in trust in elected leaders as opposed to appointed bureaucrats. Perceptions of government responsiveness to citizens' concerns and honesty of leaders also rise, and these improvements are largest where there are more village meetings at baseline. One of the central roles of village meetings is to receive and share information with village residents, providing some evidence on the value of a high-information environment for generating trust in government. We also find that records from school and health committees are more readily available in treatment villages. Notably, while stated willingness of citizens to participate in community development projects rises, actual participation in projects and the likelihood of voting do not. Overall, the results suggest little reason to worry that local management of a conditional cash transfer program reduces trust in government or the quality of governance—especially in high-information settings. ; IFPRI3; ISI; IFPRIOA; CRP2; 5 Strengthening Institutions and Governance; Capacity Strengthening ; DSGD; PIM ; PR ; CGIAR Research Program on Policies, Institutions, and Markets (PIM)
BASE
How does a locally-managed conditional cash transfer program impact trust in government? On the one hand, delivering monetary benefits and increasing interactions with government officials (elected and appointed) may increase trust. On the other hand, imposing paternalistic conditions, leading some to experience feelings of social stigma or guilt, and potentially permitting capture by local elites could reduce trust. This paper answers this question by exploiting the randomized introduction of a locally-managed transfer program in Tanzania in 2010, which included popular election of community management committees to run the program. The analysis reveals that cash transfers can significantly increase trust in leaders. This effect is driven by large increases in trust in elected leaders as opposed to appointed bureaucrats. Perceptions of government responsiveness to citizens' concerns and honesty of leaders also rise; these improvements are largest where there are more village meetings at baseline. One of the central roles of village meetings is to receive and share information with village residents. One indicator that governance may have improved is that records from school and health committees are more readily available in treatment villages. Notably, while the stated willingness of citizens to participate in community development projects rises, actual participation in projects and the likelihood of voting does not. Concerns that local management of a cash transfer program will destroy trust in government or reduce the quality of governance appear unfounded—especially in high-information contexts.
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How do conditional cash transfers impact health-related outcomes? This paper examines the 2010 randomized introduction of a program in Tanzania and finds nuanced impacts. An initial surge in clinic visits after 1.5 years -- due to more visits by those already complying with program health conditions and by non-compliers -- disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill. Health improvements were concentrated among children ages 0–5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing.
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In: IFPRI Discussion Paper 1863
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In: American Journal of Agricultural Economics, Band 100, Heft 3, S. 931-954
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In: IFPRI Discussion Paper No. 1594
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The purpose of this report is to provide information and analysis to government, civil society, and donors interested in improving the well-being of the rural population of Mon State. Specifically, the report analyzes the different sources of income for rural households, as well as their socioeconomic characteristics, with a view to identifying potential pathways to improving incomes, especially for poor households, and stimulating inclusive rural growth. The overall picture that emerges is one of an economy heavily dependent on services for local employment and on international migration for income. Like a two-legged stool, such an economy is potentially unstable in the face of external shocks. Diversification of the Mon State economy, including diversification and increased productivity within the agricultural sector, will lessen the relative dependence on external migration remittances and result in more resilient growth in the future. ; Non-PR ; IFPRI2; Feed the Future Innovation Laboratory for Food Security Policy (FSP) ; DSGD
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