Effect of a conditional cash transfer programme on childhood mortality:
a nationwide analysis of Brazilian municipalities

Davide Rasella PhD a, Rosana Aquino MD a, Carlos AT Santos PhD a b, Rômulo Paes-Sousa MD c, Prof Mauricio L Barreto MD a d

a Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil

b Department of Exact Sciences, State University of Feira de Santana, Feira de Santana, Bahia, Brazil

c Institute of Development Studies, University of Sussex, Brighton, UK

d Ciência, Tecnologia e Inovação em Saúde, INCT-CITECS, Salvador, Bahia, Brazil

The Lancet, Early Online Publication, 15 May 2013

Website: http://bit.ly/16A21rX

In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality.
The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education.
Transfers range from $18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections.

Methods

The study had a mixed ecological design. It covered the period from 2004—09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0—17·1%), intermediate (17·2—32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme).

Findings

Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92—0·96) for intermediate coverage, 0·88 (0·85—0·91) for high coverage, and 0·83 (0·79—0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24—0·50) and diarrhoea (0·47; 0·37—0·61).

Interpretation
A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil.

 

“……The results of our study provide evidence that a multisectoral approach, combining a large-scale conditional cash transfer programme, with the potential to act on important social health determinants, and effective primary health care, capable of attending basic health demands of the same population and of attending conditions imposed by the conditional cash transfer programme, can substantially reduce childhood mortality from poverty-related causes in a large middle-income country such as Brazil…………….”

Funding

National Institutes of Science and Technology Programme,
 Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.

 

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