Conditional cash transfers and health

The march of capitalism, with its reduced emphasis on public spending, while improving many national economies has also widened the gap between the rich and the poor. For millions of Indians, hunger is routine, malnutrition rife, employment insecure, health care expensive and livelihoods are under threat, arguing for an urgent need for social security. Over 80 per cent of the world's population lives in conditions without any guarantees to manage life's risks. The United Nations and other international agencies have argued that only 2 per cent of the world's Gross Domestic Product (GDP) is required to provide basic social security to the world's poor. They contend that such programmes provide growth with equity and are in the national interest of many countries.

Successful social protection programmes, many of them in South America, have demonstrated the use of innovative social security schemes and have countered capitalism's attempts to roll back social expenditures, cut deficits and finance fiscal stimulus packages for the economy. Argentina's universal child allowance programme and Brazil and Mexico's conditional cash transfer schemes are credited with reducing poverty and improving the health of populations. South Africa's Child Support Grants and Thailand's universal health care are also notable successes. Most of these schemes run on less than 0.5 per cent of national GDPs.

Redistributive transfers are not only desirable but are also hallmarks of civilised nations. They have multiplier effects and create more secure societies. Nevertheless, the philosophy, structures, economics and impact of these innovations are debated. Do they add to existing nutrition, health, education and employment services? Or do they replace existing public services and provisions? Are conditional cash transfer programmes a panacea to reduce poverty and improve health? Two schemes related to health are discussed here to highlight the complexity of the issues involved.

JSY a success: The Janani Suraksha Yojana (JSY) scheme is a conditional cash transfer (CCT) scheme to incentivise the use of health services. It is an intervention for safe motherhood and aims at reducing maternal and neo-natal mortality among poor women by encouraging institutional deliveries. It integrates financial assistance with delivery and post-delivery care for the mother and baby. The scheme also provides for the identification of pregnant women, antenatal care, assistance with transport and certification, postnatal care, and support and counselling services. Recent additions to these services include the cost of all medication and treatments, blood transfusions, consumables and diet. In some States, the scheme is complemented by the provision of public funds to private service providers in rural areas.