Who chooses? a response to Jishnu Das

There was widespread admiration in my Twitter stream yesterday for an article by World Bank Senior Economist Jishnu Das slamming The Economist for its support for making cash transfers to the poor conditional. I am less convinced by it.

Jishnu finds it ‘ridiculous’ that the Economist could reach the conclusion that conditional transfers are attractive based on the following evidence:

School enrolment among families that got conditional grants rose by 41% on average in the various programmes; the increase among those that got unconditional grants was only 23%. If conditions were implicit or soft (eg, if recipients were simply encouraged to take children to school), enrolment merely rose by 25%. The big difference came when conditions were tough (eg, if school attendance was mandatory): that boosted enrolment by 60%, a big bang for the relatively few bucks involved.

As he sees it, without conditions, parents are able to take better account of their own priorities, favouring nutrition or healthcare over education, or simply spending the money on beer so they can relax after a long day at work.

Any imposition of conditions suggests that donors know better than parents and is an example of the ‘purely elitist’ mind-set that bedevils development. “Has our hubris really taken us that far?” he asks, despairingly. “What happened to respect for the poor?” Continue reading

More on cash incentives for AIDS prevention

Last May I wrote about a World Bank scheme to pay Tanzanians to test negative for sexually transmitted infections (a proxy for HIV/AIDS), and about the positive effects on health of Mexico’s Oportunidades conditional cash transfer programme (South Africa’s pension scheme has also had beneficial health impacts, as have programmes to pay US drug users not to inject).

A new study by Rebecca Thornton lends further support to the idea that financial incentives should play a part in HIV prevention. In a randomised trial of over 2,000 Malawians, she gave some participants money in return for testing for HIV and finding out their results. Those receiving the cash were on average twice as likely to turn up to be tested as those left empty-handed. Even pretty small sums, amounting to a tenth of a day’s wage, had a significant effect on the likelihood of getting tested.

Unfortunately, Ms Thornton also found that being tested didn’t have much impact on sexual behaviour (though several other studies have found that knowing you’re HIV-positive makes you less likely to indulge in unsafe sex). Still, cash incentives could be used to persuade the reluctant to adopt other preventative measures, like male circumcision, condom use or, as the World Bank hopes, to find their own ways of staying negative.

H/T Chris Blattman.