Conditional cash transfers improve birth registration and school attendance amongst orphans and vulnerable children in Manicaland, Zimbabwe

Laura Robertson, Phyllis Mushati, Jeff Eaton, Morten Skovdal, Lovemore Dumba, Gideon Mavise, Mr

Makoni, Christina Schumacher, Tom Crea, Roeland Monasch, Lorraine Sherr, Geoff Garnett, Constance

Nyamukapa, Simon Gregson

Cluster-randomised controlled trial of conditional & unconditional cash transfers in Manicaland, Zimbabwe

• 30 rural clusters, matched on socio-economic characteristics & randomised to 3 trial arms: UCT, CCT & control

• Sept 2009: completed baseline census; May 2011: completed follow-up census

• Eligible households: care for children < 18 years, not in richest quintile of households & meet at least one criteria:– Poorest quintile of households– Cares for one or more orphans (under 18 years)– Household head is under 18 years– Chronically ill or disabled household member (any age)

• Jan 2010-Jan 2011: eligible households in UCT & CCT arms received US$18 every two months & an extra $4 per child (max 3 children)

• CCT arm: households monitored for compliance:– Birth certificates for children < 18 years, including newborns within 3 months.– Children < 5 years: up-to-date with vaccinations & attend growth monitoring twice per

year.– Children 6-17 years: attend school >= 90% of school days per month.– 1 adult must attend 2/3 parenting skills classes

Flow diagram: clusters & households30 clusters

4,043 households

Baseline UCT arm10 clusters

1,525 households 

Baseline control arm10 clusters

1,199 households 

Baseline CCT arm10 clusters

1,319 households 

Followed CCT arm10 clusters

1,248 households (95%) 

Followed UCT arm10 clusters

1,452 households (95%) 

Followed control arm10 clusters

1,118 households (93%) 

42 migrated3 refused26 unknown

48 migrated0 refused25 unknown

46 migrated1 refused34 unknown

Primary & secondary endpoints

Primary & secondary endpoints

Mean of cluster level percentages

Absolute increase in percentage (95% CI) N=30

Control UCT CCT UCT vs. Control CCT vs. Control

Births registered (children 0-4 years) 45% 47% 62% 1.5%

(-7.1-10.1)16.4%

(7.8-25.0)

Complete vaccination record (children 0-4 years) 75% 78% 77% 3.1%

(-3.8-9.9)1.8%

(-5.0-8.7)

School attendance >= 80% (children 6-12 years) 79% 86% 87% 7.2%

(0.8-13.7)7.6%

(1.2-14.1)

School attendance >= 80% (children 13-17 years) 80% 88% 91% 7.9%

(1.4-14.4)10.4%

(3.9-16.9)

• Intention-to-treat analysis

• Effect of interventions: cluster-level linear regression models adjusted for matched study design

Acknowledgments

• Partnership for Child Development & World Bank• Wellcome Trust • UNICEF Zimbabwe • Manicaland HIV/AIDS Prevention Project team• Catholic Relief Services• DOMCCP• Study participants