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Open Access Research article

The impact of Brazil’s Bolsa Família conditional cash transfer program on children’s health care utilization and health outcomes

Amie Shei1*, Federico Costa23, Mitermayer G Reis2345 and Albert I Ko23

Author Affiliations

1 Analysis Group, Inc., 111 Huntington Avenue, 10th Floor, Boston, MA 02199, USA

2 Fundação Oswaldo Cruz (FIOCRUZ), Centro de Pesquisas Gonçalo Moniz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA 40296-710, Brazil

3 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, LEPH Room 319B, P.O. Box 208034, New Haven, CT 06520-8034, USA

4 Bahia School of Medicine, Federal University of Bahia, Largo do Terreiro de Jesus - Centro Histórico, Salvador, BA 40025-010, Brazil

5 Bahiana School of Medicine and Public Health, Av. Dom João VI, 274, Brotas, Salvador, BA 40285-001, Brazil

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BMC International Health and Human Rights 2014, 14:10  doi:10.1186/1472-698X-14-10

Published: 1 April 2014

Abstract

Background

Conditional cash transfer (CCT) programs provide poor families with cash conditional on investments in health and education. Brazil’s Bolsa Família program began in 2003 and is currently the largest CCT program in the world. This community-based study examines the impact of Bolsa Família on child health in a slum community in a large urban center.

Methods

In 2010, detailed household surveys were conducted with randomly selected Bolsa Família beneficiaries and non-beneficiaries in a Brazilian slum community of approximately 14,000 inhabitants in a large urban center. 567 families (with 1,266 children) were interviewed. Propensity score methods were used to control for differences between beneficiary and non-beneficiary children to estimate program impacts on health care utilization and health outcomes.

Results

Bolsa Família has increased the odds of children’s visits to the health post for preventive services. In children under age seven, Bolsa Família was associated with increased odds for growth monitoring (OR = 3.1; 95% CI 1.9-5.1), vaccinations (OR = 2.8; 95% CI 1.4-5.4), and checkups (OR = 1.6; 95% CI 0.98-2.5), and with the number of growth monitoring visits (β = 0.6; p = 0.049) and checkups (β = 0.2; p = 0.068). There were positive spillover effects on older siblings (ages 7-17) no longer required to meet the health conditionalities. Bolsa Família increased their odds for growth monitoring (OR = 2.5; 95% CI 1.3-4.9) and checkups (OR = 1.7; 95% CI 0.9-3.2) and improved psychosocial health (β = 2.6; p = 0.007).

Conclusions

Bolsa Família has improved health care utilization, especially for services related to the health conditionalites, and there were positive spillover effects on older siblings. The findings of this study are promising, but they also suggest that further improvements in health may depend on the quality of health care services provided, the scope of services linked to the health conditionalities, and coordination with other social safety net programs.