AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #125 - Cash transfer targeting strategies in Zimbabwe: Are we reaching all vulnerable children?
Authors: Presenting Author: Dr Constance Nyamukapa - Imperial College, London
Additional Authors: Dr. Laura Robertson, Ms. Phyllis Mushati, Prof. Lorraine Sherr, Mr. J.C. Makoni, Prof. Tom Crea, Mr. Gideon Mavise, Dr. Christina Schumacher, Mr. Jeffrey Eaton, Mr. Lovemore Dumba, Prof. Simon Gregson,
Aim: Cash transfer programmes provide support to children in low income countries suffering from severe HIV epidemics. It is important that these programmes reach the most vulnerable households and children. We compared inclusion rates for vulnerable and “non-vulnerable” children associated with three different targeting strategies commonly used to identify households caring for OVC: (i) vulnerable household characteristics (e.g. child-headed, caring for orphaned children or chronically-ill or disabled people), (ii) dependency ratios/labour-constrained households, and (iii) poverty (wealth index constructed from data on household assets).
Method / Issue: Household census data were used to compare the proportion of vulnerable children (defined as those with negative school enrolment, birth registration and vaccination status outcomes) that would be reached under each of the three targeting strategies and the percentage of “non-vulnerable” children (defined as those with positive outcomes) that would be included. We also compared levels of inclusion achieved by applying multiple combination strategies with those achieved using individual strategies.
Results / Comments: Over 10,000 households caring for children were enumerated. Targeting vulnerable households (Strategy (i)) included the highest proportion of children with poor health and educational outcomes (ranging from 49% of children aged 0-4 years with incomplete vaccination records to 70% of children aged 13-17 years not enrolled in secondary school). Targeting only poor households (Strategy (iii)) gave a lower proportion of children with poor health and educational outcomes (less than 25% for all outcomes). Targeting based on dependency ratios (Strategy (ii)) gave mixed results (e.g. 21% of children with incomplete vaccination records versus 42% of children aged 6-12 years not attending primary school). The proportions of children with positive health and education outcomes reached under each targeting strategy generally were somewhat lower than the proportions of children with negative outcomes reached for all three targeting strategies, although these proportions typically were quite high (often greater than 20%). Increasing the number of targeting strategies applied was associated with increases in the proportion of children aged 0-4 years included without a birth certificate (test for trend p=0.08) and the proportion of children aged 6-12 years (test for trend p=0.001) and 13-17 years (test for trend p<0.001) not enrolled in school. This trend was not found for the proportion of children aged 0-4 years with incomplete vaccination records.
Discussion: In Manicaland, Zimbabwe, targeting vulnerable or labour-constrained households results in a high proportion of children with negative health, education and birth registration outcomes being reached. However, these methods also result in a sizeable proportion of children with positive outcomes being targeted. Combination strategies may be the best method of ensuring vulnerable children are not excluded from cash transfer programmes.
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