Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25 Health education for microcredit clients in Peru: a randomized controlled trial Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol Effects of Financial Incentives on Saving Outcomes and Material Well-Being: Evidence From a Randomized Controlled Trial in Uganda. The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment A multilevel analysis of the effect of Malawi's Social Cash Transfer Pilot Scheme on school-age children's health. Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. The effect of a monetary incentive on return of a postal health and development questionnaire: a randomised trial [ISRCTN53994660] Conditional cash transfers to improve education and health: an ex ante evaluation of Red de Protección Social, Nicaragua. Integrating group counseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women's adherence to international breastfeeding recommendations. The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomised controlled trial. The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women
BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa Background Poverty , lack of female empowerment , and lack of education are major risk factors for childhood illness worldwide . Microcredit programs , by offering small loans to poor individuals , attempt to address the first two of these risk factors , poverty and gender disparity . They provide clients , usually women , with a means to invest in their businesses and support their families . This study investigates the health effects of also addressing the remaining risk factor , lack of knowledge about important health issues , through r and omization of members of a microcredit organization to receive a health education module based on the World Health Organization 's Integrated Management of Childhood Illness ( IMCI ) community intervention . Methods Baseline data were collected in February 2007 from clients of a microcredit organization in Pucallpa , Peru ( n = 1,855 ) and their children ( n = 598 ) . Loan groups , consisting of 15 to 20 clients , were then r and omly assigned to receive a health education intervention involving eight monthly 30-minute sessions given by the organization 's loan officers at monthly loan group meetings . In February 2008 , follow-up data were collected , and included assessment s of sociodemographic information , knowledge of child health issues , and child health status ( including child height , weight , and blood hemoglobin levels ) . To explore the effects of treatment ( i.e. , participation in the health education sessions ) on the key outcome variables , multivariate regressions were implemented using ordinary least squares . Results Individuals in the IMCI treatment arm demonstrated more knowledge about a variety of issues related to child health , but there were no changes in anthropometric measures or reported child health status . Conclusions Microcredit clients r and omized to an IMCI educational intervention showed greater knowledge about child health , but no differences in child health outcomes compared to controls . These results imply that the intervention did not have sufficient intensity to change behavior , or that microcredit organizations may not be an appropriate setting for the administration of child health educational interventions of this type . Trial Registration This study is registered with Clinical Trials.gov , NCT01047033 Objective To assess the effectiveness of an integrated early child development intervention , combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia , for children ’s development , growth , and hemoglobin levels . Design Cluster r and omized controlled trial , using a 2 × 2 factorial design , with municipalities assigned to one of four groups : psychosocial stimulation , micronutrient supplementation , combined intervention , or control . Setting 96 municipalities in Colombia , located across eight of its 32 departments . Participants 1420 children aged 12 - 24 months and their primary carers . Intervention Psychosocial stimulation ( weekly home visits with play demonstrations ) , micronutrient sprinkles given daily , and both combined . All delivered by female community leaders for 18 months . Main outcome measures Cognitive , receptive and expressive language , and fine and gross motor scores on the Bayley scales of infant development-III ; height , weight , and hemoglobin levels measured at the baseline and end of intervention . Results Stimulation improved cognitive scores ( adjusted for age , sex , testers , and baseline levels of outcomes ) by 0.26 of a st and ard deviation ( P=0.002 ) . Stimulation also increased receptive language by 0.22 of a st and ard deviation ( P=0.032 ) . Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions . No intervention affected height , weight , or hemoglobin levels . Conclusions Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children ’s cognitive development . We found no effect of supplementation on developmental or health outcomes . Moreover , supplementation did not interact with stimulation . The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development . Trial registration Current Controlled trials IS RCT N18991160 OBJECTIVE To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic . One community had only the health promotion program , one community had only the microcredit program , and one community had both a health promotion program and a microcredit program .  This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program , that there would be intermediate changes in the community with only a health promotion program , and that the smallest changes would be in the community with only a microcredit program . METHODS The health promotion programs used  community volunteers  to address two major concerns : ( 1 ) the prevalent causes of mortality among children under 5 years of age and ( 2 ) women 's health ( specifically breast and cervical cancer screening ) . The microcredit program made small loans to individuals to start or exp and small businesses . Outcome measures were based on comparisons for 11 health indicators from baseline community surveys ( 27 households surveyed in each of the three communities , done in December 2000 and January 2001 ) and from follow-up surveys ( also 27 households surveyed in each of the three communities , in June and July 2002 , after the health promotion program had been operating for about 13 months ) . Households were r and omly chosen during both the baseline and follow-up surveys , without regard to their involvement in the microcredit or health promotion programs . RESULTS The health indicators improved in all three communities . However , the degree of change was different among the communities ( P < 0.001 ) . The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators . CONCLUSIONS Multisector development is known to be important on a macroeconomic scale . The results of this pilot project support the view that multisector development is also important on a microeconomic level , given that the parallel microcredit and health promotion programs result ed in greater change in the measured health indicators than either program alone . As far as we authors know , this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program BACKGROUND Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries by lack of dem and . In Latin America , some governments have been trying to increase dem and for health interventions by making direct payments to poor households contingent on them keeping up-to- date with preventive health services . We undertook a public health programme effectiveness trial in Honduras to assess this approach , contrasting it with a direct transfer of re sources to local health teams . METHODS 70 municipalities were selected because they had the country 's highest prevalence of malnutrition . They were allocated at r and om to four groups : money to households ; re sources to local health teams combined with a community-based nutrition intervention ; both packages ; and neither . Evaluation surveys of about 5600 households were undertaken at baseline and roughly 2 years later . Pregnant women and mothers of children younger than 3 years old were asked about use of health services ( primary outcome ) and coverage of interventions such as immunisation and growth monitoring  ( secondary outcome ) . Reports were supplemented with data from children 's health cards and government service utilisation data . Analysis was by mixed effects regression , accounting for the municipality-level r and omisation . FINDINGS The household-level intervention had a large impact ( 15 - 20 percentage points ; p<0.01 ) on the reported coverage of antenatal care and well-child check-ups . Childhood immunisation series could thus be started more opportunely , and the coverage of growth monitoring was markedly increased ( 15 - 21 percentage points ; p<0.01 . Measles and tetanus toxoid immunisation were not affected . The transfer of re sources to local health teams could not be implemented properly because of legal complications . INTERPRETATION Conditional payments to households increase the use and coverage of preventive health care interventions Background The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries . Previous review s of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions . This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors , including : smoking cessation , increased physical activity , healthier dietary intake , sensible patterns of alcohol consumption , safe sun , safe sex , and primary preventive clinical behaviors . Methods Systematic methods will be used to search existing literature and screen studies for inclusion . All studies that meet the following inclusion criteria will be included in the review : participants were 18 years old or older and living in high-income countries ; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors , or cash or cash-like penalties to discourage unhealthy behaviors ; the comparator was usual care or no intervention ; study design was r and omized controlled trial , cluster r and omized controlled trial , controlled before and after study , or interrupted time series analysis . Two review ers will independently screen the publications to ensure they meet the inclusion criteria . Quality will be assessed by two research ers , working independently , using the Cochrane risk of bias tool . Meta- analysis will be conducted , if appropriate . Any studies identified as at ‘ high risk of bias ’ will be excluded from meta- analysis . Discussion This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors The use of savings products to promote financial inclusion has increasingly become a policy priority across sub-Saharan Africa , yet little is known about how families respond to varying levels of savings incentives and whether the promotion of incentivized savings in low-re source setting s may encourage households to restrict expenditures on basic needs . Using data from a r and omized controlled trial in Ug and a , we examine : 1 ) whether low-income households enrolled in an economic-empowerment intervention consisting of matched savings , workshops , and mentorship  reduced spending on basic needs and 2 ) how varied levels of matching contributions affected household savings and consumption behavior . We compared primary school-attending AIDS-affected children ( N = 1,383 ) r and omized to a control condition with two intervention arms with differing savings-match incentives : 1:1 ( Bridges ) and 1:2 ( Bridges PLUS ) . We found that : 1 ) 24 months post-intervention initiation , children in Bridges and Bridges PLUS were more likely to have accumulated savings than children in the control condition ; 2 ) higher match incentives ( Bridges PLUS ) led to higher deposit frequency but not higher savings in the bank ; 3 ) intervention participation did not result in material hardship ; and 4 ) in both intervention arms , participating families were more likely to start a family business and diversify their assets Background Financial incentives are often used to influence professional practice , yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood . In keeping with clinical guidelines , Childsmile ( Scotl and ’s oral health improvement programme ) advocates twice yearly fluoride varnish application ( FVA ) for children in dental practice . To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds ’ teeth through a pilot . In October 2011 payment was extended to all dental practitioners . This paper compares FVA pre- and post-roll-out and explores the financial incentive ’s behavioural mechanisms . Methods A natural experimental approach using a longitudinal cohort of dental practitioners ( n = 1090 ) compared FVA pre- ( time 1 ) and post- ( time 2 ) financial incentive . Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients ( novel incentive group )  were compared with all other responses ( continuous incentive group ) . The Theoretical Domains Framework ( TDF ) was used to measure change in behavioural mechanisms associated with the incentive . Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups . Results At time 2 , 709 74 % , of eligible responders , were followed up . In general , FVA rates increased over time for both groups ; however , the novel incentive group experienced a greater increase ( β [ 95 % CI ] = 0.82 [ 0.72 to 0.92 ] ) than the continuous incentive group . Despite this , only 33 % of practitioners reported ‘ always ’ varnishing increased risk 2–5-year-olds ’ teeth following introduction of the financial incentive , 19 % for st and ard risk children . Domain scores at time 2 ( adjusting for time 1 ) increased more for the novel incentive group ( compared to the continuous incentive group ) for five domains : knowledge , social/professional role and identity , beliefs about consequences , social influences and emotion . Conclusions In this large , prospect i ve , population -wide study , a financial incentive moderately increased FVA in dental practice . Novel longitudinal use of a vali date d theoretical framework to underst and behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems . While financial incentives are useful in narrowing the gap between clinical guidelines and FVA , multiple intervention approaches are required OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 PURPOSE This study investigates the causal effect of Kenya 's  unconditional cash transfer program on  mental health outcomes of young people . METHODS Selected locations in Kenya were r and omly assigned to receive unconditional cash transfers  in the first phase of Kenya 's Cash Transfer Program for orphans and Vulnerable Children . In intervention locations , low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $ 20 in 2007 . In 2011 , 4 years after program onset , data were collected on the psychosocial status for youth aged 15 - 24 years from households in intervention and control locations ( N = 1960 ) . The primary outcome variable was an indicator of depressive symptoms using the 10- question Center for Epidemiologic Studies Depression Scale . Secondary outcomes include an indicator for hopefulness and physical health measures . Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program . RESULTS The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers . Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20 - 24 years and orphans . CONCLUSIONS This study provides evidence that poverty-targeted unconditional cash transfer programs , can improve the mental health of young people in low-income countries Background Postal question naires are widely used to collect data in healthcare research but a poor response rate may reduce the validity and reliability of results . There was a lack of evidence available relating to use of a monetary incentive to improve the response rate in the healthcare setting . Methods The MRC ORACLE Children Study is assessing the health and development of nearly 9000 seven year old children whose mothers ' joined the MRC ORACLE Trial . We carried out a r and omised controlled trial of inclusion of monetary incentive ( five pound voucher redeemable at many high street stores ) with the reminder question naire to parents . This trial took place between April 2002 and November 2003 . When the parents were sent the reminder question naire about their child 's health and development they were r and omly assigned by concealed computer-generated allocation stratified by week of birthday to receive a five pound voucher or no incentive . The population were 722 non-responders to the initial mailing of a 12-page question naire . Main outcome measures : Difference in response rate between the two groups . Results Inclusion of the voucher with the reminder question naire result ed in a 11.7%(95 % CI 4.7 % to 18.6 % ) improvement in the response rate between the two groups . Conclusion This improvement in response rate and hence the validity and reliability of results obtained appears to be justified ethically and financially Using baseline data from a r and omized experiment , this article extends and tests in the context of health , the feasibility of a recently proposed reduced form approach to ex ante evaluations of social programs with an application to a  conditional cash transfer program in Nicaragua . It uses a behavioural model to estimate the impact on preventive care utilization outcomes for children younger than 3 years . It vali date s the model with the results of the experiment and then simulates two alternate policy scenarios . The model performs well in predicting the health related outcomes and shows different results for the two sets of policy scenarios . In addition , simulations are also carried out for the school component of the cash transfer program In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practice s. This intervention could be scaled up in Nigeria , where local organizations provide microcredit to > 500,000 clients . Furthermore , the intervention could be adopted more widely given that > 150 million women , many of childbearing age , are involved in microfinance globally BACKGROUND Cash transfers have been proposed as an intervention to reduce HIV-infection risk for young women in sub-Saharan Africa . However , scarce evidence is available about their effect on reducing HIV acquisition . We aim ed to assess the effect of a conditional cash transfer on HIV incidence among young women in rural South Africa . METHODS We did a phase 3 , r and omised controlled trial ( HPTN 068 ) in the rural Bushbuckridge subdistrict in Mpumalanga province , South Africa . We included girls aged 13 - 20 years if they were enrolled in school grade s 8 - 11 , not married or pregnant , able to read , they and their parent or guardian both had the necessary documentation necessary to open a bank account , and were residing in the study area and intending to remain until trial completion . Young women ( and their parents or guardians ) were r and omly assigned ( 1:1 ) , by use of numbered sealed envelopes containing a r and omisation assignment card which were numerically ordered with block r and omisation , to receive a monthly cash transfer conditional on school attendance ( ≥80 % of school days per month ) versus no cash transfer . Participants completed an Audio Computer-Assisted Self-Interview ( ACASI ) , before test HIV counselling , HIV and herpes simplex virus (HSV)-2 testing , and post-test counselling at baseline , then at annual follow-up visits at 12 , 24 , and 36 months . Parents or guardians completed a Computer-Assisted Personal Interview at baseline and each follow-up visit . A stratified proportional hazards model was used in an intention-to-treat analysis of the primary outcome , HIV incidence , to compare the intervention and control groups . This study is registered at Clinical Trials.gov ( NCT01233531 ) . FINDINGS Between March 5 , 2011 , and Dec 17 , 2012 , we recruited 10 134 young women and enrolled 2537 and their parents or guardians to receive a cash transfer programme ( n=1225 ) or not ( control group ; n=1223 ) . At baseline , the median age of girls was 15 years ( IQR 14 - 17 ) and 672 ( 27 % ) had reported to have ever had sex . 107 incident HIV infections were recorded during the study : 59 cases in 3048 person-years in the intervention group and 48 cases in 2830 person-years in the control group . HIV incidence was not significantly different between those who received a cash transfer ( 1·94 % per person-years ) and those who did not ( 1·70 % per person-years ; hazard ratio 1·17 , 95 % CI 0·80 - 1·72 , p=0·42 ) . INTERPRETATION Cash transfers conditional on school attendance did not reduce HIV incidence in young women . School attendance significantly reduced risk of HIV acquisition , irrespective of study group . Keeping girls in school is important to reduce their HIV-infection risk . FUNDING National Institute of Allergy and Infectious Diseases , National Institute of Mental Health of the National Institutes of Health Recent evidence suggests that conditional cash transfer programs for schooling are effective in raising school enrollment and attendance . However , there is also reason to believe that such programs can affect other outcomes , such as the sexual behavior of their young beneficiaries .  Zomba Cash Transfer Program is a r and omized , ongoing conditional cash transfer intervention targeting young women in Malawi that provides incentives ( in the form of school fees and cash transfers ) to current schoolgirls and recent dropouts to stay in or return to school . An average offer of US$ 10/month conditional on satisfactory school attendance – plus direct payment of secondary school fees – led to significant declines in early marriage , teenage pregnancy , and self-reported sexual activity among program beneficiaries after just one year of program implementation . For program beneficiaries who were out of school at baseline , the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent , respectively . In addition , the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group . Overall , these results suggest that conditional cash transfer programs not only serve as useful tools for improving school attendance , but may also reduce sexual activity , teen pregnancy , and early marriage
The quality of evidence on the effect of financial incentives on breastfeeding practice s was low but seems to indicate a potential positive impact on receiving colostrum , early initiation of breastfeeding , exclusive breastfeeding and mean duration of exclusive breastfeeding .
There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization .
Conclusions Financial incentives may have potential to promote increased coverage of several important child health interventions , but the quality of evidence available is low .
The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services .
Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits .
This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers
Background Financial incentives are widely used strategies to alleviate poverty , foster development , and improve health .
Cash transfer programs , microcredit , user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America , Sub-Saharan Africa , and more recently in Southeast Asia .
Until now , no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted .
The objective of this review is to provide estimates on the effect of six types of financial incentive programs : ( i ) Unconditional cash transfers ( CT ) , ( ii ) Conditional cash transfers ( CCT ) , ( iii ) Microcredit ( MC ) , ( iv ) Conditional Microcredit ( CMC ) , ( v ) Voucher schemes ( VS ) and ( vi ) User fee removal ( UFR ) on the uptake and coverage of health interventions targeting children under the age of five years .