Cash Transfers for Child Health Initiative - Funded Projects

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As the initiative develops and awards funding, initiative staff will update this page to include the latest list of programing funded through RFPs. Additionally, the latest publications and links to data from CaTCH funded projects will be available here. Click on the orange states or their corresponding labels on the map below to see projects in that region.

Map of India with the states of Bihar, Delhi, Gujarat, Haryana, Jharkhand, Rajasthan, Madhya Pradesh, and Tamil Nadu colored in

Bihar

Improving Timely Vaccination through Incentives and Automating Workflow of Frontline Health Workers using Information and Communication Technology
Researchers: Sisir Debnath, Sarang Deo
Timeline: 2019-2020
Government Partner: State Health Society, Bihar
Type of Project: Pilot Study
Status: Ongoing

Despite a significant increase in vaccine coverage in India, more than 20% of child deaths in 2008 were caused by three vaccine-preventable diseases alone. A major underlying factor behind these deaths is lack of vaccine effectiveness caused by delays in vaccination. As most vaccines are available for free at public facilities, it is mostly non-price factors such as lack of awareness that cause delays - caregivers in rural communities often lack appropriate information regarding the health benefits of vaccines and the time and place to avail them. Additionally, supply side-factors such as the lack of incentives for timeliness and outdated workflow management for frontline health workers are also responsible. In India, vaccinations are delivered by regular frontline health workers or Auxiliary Nurse Midwife (ANM) who is assisted by a village level Accredited Social Health Activist (ASHAs). Most ANMs are regular government employees, and their salaries are rigid, formulaic, and independent of their performance while the ASHAs are paid according to fee-for-service. The pilot study will assess the technical feasibility of an Information and Communication Technology (ICT) platform designed to improve FHW workflow and collect primary data on various other components that will be used to implement a large-scale RCT to study the effects of pay-for-performance to FHWs, an improved workflow management, and reminder calls to caregivers on timeliness of vaccine and coverage. 

Delhi

Transfers and Targeting for Health: Optimizing the Design of Maternity Benefits
Researchers: Simone Schaner, Jessica Leight, Jan Cooper, Sarika Gupta
Timeline: 2017-2018
Government Partner: Department of Women and Child Development, Delhi
Type of Project: Pilot Study
Status: Completed

The team’s research aims to (a) learn about current deficiencies in maternal and newborn health in Delhi and (b) understand barriers, both social and institutional, to improving outcomes. This work hopes to inform the design of a full evaluation of a planned maternity cash transfer program to be conducted in partnership with the Government of Delhi. Subsequent research hopes to understand cash transfer design aspects like varying the conditionality of the transfer, the identity of the recipient, and the timing of the transfer in order maximize beneficiary impact and program cost effectiveness.

Gujarat

The Impact of Financial Incentives on ASHA’s Performances and Health Outcomes
Researchers: Martina Björkman Nyqvist, Andrea Guariso
Timeline: 2019-2020
Government Partner: Department of Health and Family Welfare, Gujarat
Type of Project: Pilot Study
Status: Ongoing

Gujarat has in recent years experienced significant improvements across a number of key health indicators from NFHS-3 to 4. However, large gaps remain especially in the take-up of maternal and child health services. As an example, in Gujarat only 24% of mothers had full ANC care (as per data from NFHS-4). In order to address the health needs of the most vulnerable parts of society, in 2005 the Government of India created a new figure of community based functionaries, called Accredited Social Health Activist (ASHA). ASHAs are meant to be the first port of call for any health-related demands of deprived sections of the population, especially women and children, who have difficulties in accessing health services. However, the ASHAs are honorary volunteers and do not receive any salary or honorarium, although they are supposed to receive compensation for completion of some specific activities. Hence, they currently face very limited financial incentives to perform their task. Dissatisfaction with incentives can lead to lower health worker motivation, and negatively affect performances. This project aims at achieving the desired improvements in health outcomes by strengthening the existing ASHA cadre of frontline workers. Specifically, the pilot and scoping study is designed to lead into a full evaluation, which aims at studying whether pay-for-performance, fixed pay, or an entrepreneurial approach to health delivery have different impact on community health worker performance and, in that case, how and why.

Haryana

Demand and Supply-Side Incentives to Improve Maternal and Child Health Outcomes for Young Women in Haryana, India: A Scoping Study for Optimal Design
Researchers: Sarah Baird, Jan Cooper, John Hoddinott, Craig McIntosh, Berk Özler

Timeline: 2018
Government Partner: National Health Mission, Haryana
Type of Project: Pilot
Status: Ongoing

Adolescent pregnancy remains a major determinant of maternal and child mortality and morbidity globally, with pregnancy and childbirth complication the leading cause of death among 15-19 year-old girls. In Haryana, the proposed state for this study, 19% of 20-24 year olds had a child before the age of 20. Furthermore, adolescents and unmarried women are often left out of good quality care. This pilot proposal aims to (a) better understand the determinants of adolescent pregnancy and (b) learn about demand and supply side barriers to better maternal and child outcomes for young (15-24 year-old) women. The objective of this pilot work is to inform the design of a full evaluation with the National Health Mission of Haryana that tests the relative cost-effectiveness of combinations of supply and demand (unconditional and conditional cash transfers) side interventions with respect to maternal and child health outcomes.

Jharkhand

Targeted Unconditional Framed Cash Transfers for Early Childhood Health and Nutrition
Researchers: Karthik MuralidharanPaul NiehausSandip SukhtankarJeff Weaver
Timeline: 2017-2018
Government Partner: Jharkhand Nutrition Mission and Department of Women and Child Development & Social Welfare
Type of Project: Pilot Study
Status: Completed

Although child health in India has improved over the last decade, many outcomes remain shockingly poor: in the context of our study, 45% of children under five are stunted and 29% are wasted. One promising intervention for improving child health is making unconditional cash transfers to mothers for the purchase of additional food. Researchers will test whether unconditional cash transfers made by a state government actually improve long-run child health outcomes and how to optimize the timing of transfers. The study will provide evidence on the situations in which cash transfer programs are effective, and whether these should be scaled up by the government.

Targeted Unconditional Framed Cash Transfers for Early Childhood Health and Nutrition
Researchers: Karthik MuralidharanPaul NiehausSandip SukhtankarJeff Weaver
Timeline: 2018-2020
Government Partner: Jharkhand Nutrition Mission and Department of Women and Child Development & Social Welfare
Type of Project: Full Evaluation
Status: Ongoing

This study will evaluate whether framed, unconditional cash transfers (UCT) to pregnant women and lactating mothers improve the health of their children, as measured by incidence of stunting and wasting. This will be the first randomized evaluation in India of unconditional cash transfers for maternal and child health, and will be implemented by the Government of Jharkhand (GoJH) in eight districts. The current proposal is for a study of the impact of a 12-month long UCT to pregnant and lactating mothers. If the first phase is successfully implemented, the design (and MoU) will allow for a second phase evaluation that will evaluate the impact of UCTs on health of children in the 6 to 18-months age range, and also test for complementarities between receipt of UCTs at different stages of child development.

Madhya Pradesh

India's New Maternity Benefit Scheme (PMMVY): Scoping Potential Randomized Interventions to Improve Impact
Researchers: Manoj Mohanan, Grant Miller, Usha Ramakrishnan, Alessandro Tarozzi, Harsha Thirumurthy
Timeline: 2018 - 2019
Government Partner: Government of Madhya Pradesh and Niti Aayog
Type of Project: Pilot
Status: Complete

In an attempt to improve health and nutrition outcomes among both pregnant women and lactating mothers (PW&LM) and children under 5 (U5), the Government of India (GoI) launched the Pradhan Mantri Matru Vandana Yojana (PMMVY) in 2017 to provide a conditional cash transfer (CCT) of Rs. 5,000 to first-time PW&LM. While CCT’s are a common policy tool worldwide, there are still research gaps in understanding how cash transfers impact health and nutrition outcomes. Likewise, there is limited understanding of how program implementation, especially in India, contributes to program impact. This pilot aims to conduct both quantitative and qualitative data collection on barriers to PW&LM in a) utilizing PMMVY and b) investing in newborn health and nutrition, with the ultimate purpose of informing the design of RCTs to reduce such barriers. The proposed project will take place in partnership with NITI Aayog (GoI’s main policy think tank) and support current World Bank efforts to strengthen health systems in the Government of Madhya Pradesh. 

Micro-Evaluation of intervention to improve implementation of PMMVY program delivery in Madhya Pradesh
Researchers: Manoj Mohanan, Grant Miller, Purnima Menon
Timeline: 2019 - 2020
Government Partner: Government of Madhya Pradesh and Niti Aayog
Type of Project: Full Evaluation
Status: Ongoing

In an attempt to improve health and nutrition outcomes among both pregnant women and lactating mothers (PW&LM) and infant children, the Government of India (GoI) launched the Pradhan Mantri Matru Vandana Yojana (PMMVY) in 2017 to provide a conditional cash transfer (CCT) of Rs. 5,000 (~77 USD) to first-time PW&LM. As of February 2019, PMMVY had enrolled over 7.3 million beneficiaries, with over 13% of these enrollments in the state of Madhya Pradesh (MP). After extensive review of PMMVY in several districts in MP, the researchers found several key blockages to program implementation. They propose conducting two micro-evaluations of pilot interventions implemented by the Government of Madhya Pradesh: (1) using administrative data to assess the impact of digital beneficiary enrollment on average payment times and (2) using household surveys to assess the impact of postcard reminders on beneficiary awareness of PMMVY and receipt of cash transfers. The study will provide valuable feedback on program design to improve implementation of India’s flagship cash transfer program targeting maternal health and nutrition. Moreover, the micro-evaluations set the stage for the potential overall evaluation of PMMVY through an encouragement design.

Punjab

Reducing "Stubble Burning" to improve air quality and child respiratory health
Researchers: Seema Jayachandran, Kelsey Jack, Namrata Kala, Rohini Pande 

Timeline: 2018-2019
Government Partner: Government of Punjab
Type of Project: Pilot
Status: Complete

Stubble burning (burning of fields to remove crop residue after harvest) each November in Punjab contributes to New Delhi’s high air pollution and to local air pollution in Punjab. Respiratory problems among children are one major cost of this practice. To address stubble burning, the Government of Punjab (GoP) is encouraging adoption of a tractor attachment (“Happy Seeder”) that tills the stubble into the soil, obviating the need for burning. The pilot will explore three possible interventions: (1) subsidies for Happy Seeder purchase, (2) marketing campaign to increase take-up, and (3) training on proper use to encourage adoption of this technology. GoP is interested in the effectiveness of these interventions in reducing stubble burning, and the study will also assess their impacts on local air pollution and child respiratory health. The pilot study will test and refine interventions, as a lead-in to a full-study in 2019.

Can Conditional Transfers Reduce Crop Residue Burning and Improve Child Health?
Researchers: Seema JayachandranKelsey JackNamrata KalaRohini Pande 

Timeline: 2019-2020
Government Partner: Government of Punjab
Type of Project: Pilot
Status: Ongoing

Agricultural practices that increase farmers’ productivity are sometimes accompanied by negative environmental externalities, with consequences for human health. One example is the rise in crop residue burning after mechanized harvesting was adopted in many parts of India, particularly Punjab. This evaluation will assess the effectiveness of cash transfers in reducing crop burning and, thereby, improving air quality and child health. The researchers will roll out and assess a program that offers cash transfers to farmers that are conditional on not using stubble burning to clear fields. They will also test whether information provision to farmers on how to access alternative crop residue management (CRM) technologies for field clearance (e.g., Happy Seeders) affects crop burning and child health, and whether the impact of cash transfers is higher with relevant information provision. 

Rajasthan

Leveraging Technology and Entrepreneurship to Increase Access to Welfare Programs
Researchers: Rema Hanna, Jennifer Bussell, Sarika Gupta, Ben Olken
Timeline: 2018-2019
Government Partner: Government of Rajasthan and Haqdarshak Empowerment Solutions
Type of Project: Full Evaluation
Status: Ongoing

While India administers many transfer programs for women and children, program coverage is often low as people lack the ability to navigate the complex application processes.  Previous research has shown that assistance with the process could help improve take-up of essential programs, but there has been little research conducted on what is the best way to scale “assistance” up across India.  Researchers in this study investigate the potential of leveraging technology to improve access to welfare programs. The interventions will build on an existing model called Haqdarshak, which comprises of paid door-to-door services offered by a community level facilitator to citizens to inform them of the programs they are eligible for and help them apply for these programs. This service will be offered to 10,000 vulnerable households in rural Rajasthan. The researchers will also test variations of the Haqdarshak model to understand the best way to administer it at scale.

Interventions to Improve Child Utilization of Government Health Insurance in Rajasthan
Researchers: Pascaline Dupas, Radhika Jain
Timeline: 2019-2020
Government Partner: Department of Health and Family Welfare, Rajasthan
Type of Project: Pilot
Status: Ongoing

The Government of Rajasthan (GoR) launched the BSBY program in 2015 to increase equity in health care access, utilization, and outcomes. The program pays hospitals to provide free secondary and tertiary care to poor households. Thanks to a strong partnership with GoR, the research team was able to obtain and conduct analyses of claims data since program inception. Based on analyses, the researchers found that hospitals charge patients substantial amounts for care that should be free, and that service utilization is substantially lower among young girls than young boys. In the pilot phase, the researchers aim to build on existing partnership with the GoR to 1) better understand the reasons for low utilization by children, and girls in particular, to design targeted interventions, 2) assess the feasibility and potential of different methods to strengthen hospital monitoring to reduce supply side leakages, and 3) test effective and low-cost data collection methods. Following the pilot, the researchers will collaborate with the government to cross-randomize a demand side intervention to increase take-up among children and a supply side intervention to reduce patient charges due to leakage at the hospital level. 

Tamil Nadu

Improving School Preparedness and Child Health Outcomes Through ICDS
Researchers: Karthik Muralidharan, Alejandro Ganimian, Christopher Walters
Timeline: 2017-2018
Government Partner: Integrated Child Development Services Mission
Type of Project: Full Study
Status: Ongoing

In India, programs that promote early childhood development are delivered primarily by Integrated Child Development Services (ICDS) through anganwadi centers (AWCs) staffed by anganwadi workers (AWWs). ICDS overall and AWCs in particular are under-resourced relative to their importance for human development, resulting in uneven quality (PEO, 2011). Yet, fiscal constraints make large increases in ICDS spending difficult. It is thus critical to determine the most cost-effective methods for boosting ICDS quality so that scarce resources can be directed to programs that generate maximal social value.

The researchers propose to study the impact of pay-for-performance (P4P) bonuses to frontline childcare workers on child health in the state of Tamil Nadu, using an RCT conducted across a representative sample of childcare centers. Key features of the study include: (1) The bonus will represent roughly 20% of the annual pay of each worker, a large payment that we expect will motivate workers to exert considerable extra effort; (2) The impact of the P4P program will be measured both against a control group, and against a second treatment arm where workers are provided an unconditional across-the-board pay increase equal to the average pay increase provided by the P4P program; (3) Researchers pay careful attention to the details of the P4P scheme, and aim to overcome design challenges of previous P4P schemes in health and education by adopting an optimal incentive pay formula developed in recent theoretical work.