By Giovana Cardoso.
Social assistance programs, such as conditional cash transfers, have been vital to poverty reduction efforts. Programmes like the Bolsa Familia in Brazil attached conditionalities aimed at enhancing human capital through monthly cash transfers for poor households. The impact this has had on healthcare, mainly life expectancy and infant mortality rates, show how the program has improved the quality of life for its participants.
The Bolsa Familia Program
The Bolsa Familia program (BFP) is a conditional cash transfer (CCT) program that aims to reduce poverty by providing immediate funds, attached to conditionalities, to poor families in Brazil. It also targets the vulnerable and fights the inter generational cycle of poverty by investing in human capital, mainly through education and health. Attending to 46 million people, it was created in 2003 during President Lula’s government, and was influenced by t the Millennium Development Goals of reducing malnutrition and achieving universal education. This was complemented by the understanding that poverty reduction is most effective when it addresses the underlying causes, rather than focusing on alleviating the symptoms.
The program targets the extreme poor and the poor, each classified depending on their monthly income per capita. Currently, families in extreme poverty earn less than R$89.00 (£18) monthly, and the poor have an income between R$89.01 and R$178.00 (£36.01). There are a range of benefits households can qualify for. Families living in extreme poverty are offered the basic benefit of R$89.00. Those above the line of extreme poverty but earning up to R$170.00 per capita per month qualify for variable benefits, which are dependent on the number of children aged up to 16 and pregnant or lactating women. The BFP requires all members of the family to meet the conditionalities to receive the funds.
[BFP] was complemented by the understanding that poverty reduction is most effective when it addresses the underlying causes, rather than focusing on alleviating the symptoms.
Conditionalities
For the health requirement, children aged zero to seven must maintain their vaccinations up to date. If there are pregnant or lactating women in the family, they are expected to attend prenatal appointments and participate in information sessions on nutrition and breastfeeding. Women aged 14 to 44 are obliged to attend regular check-ups in certified health centres. For the educational conditionalities, all children aged 6 to 17 must be enrolled in schools. Those aged 6 to 15 are required to attend a minimum of 85 percent of all school days. The attendance rate reduces to 75 percent for 16 and 17-year-olds.
Although the BFP has been thoroughly analysed and credited for improving school attendance and nutrition, in addition to lowering levels of inequality in Brazil, it is often assessed in the context of participants meeting the conditions set for the cash transfer. Considering the program’s aim to reduce poverty, it is important to determine if meeting the conditionalities of the program have affected long-term indicators of development. Focusing mainly on the program’s impact on healthcare, these indicators include life expectancy and infant mortality rate.
North-east Brazil is the poorest region of the country, and also where the highest number of BFP participants are. The program has had an intense effect in the region, an impact that can be attributed solely to Bolsa Familia as government spending in the health sector was static between 2000 and 2015. There were also no other active social assistance programs with a focus in healthcare during this time.
The program has had an intense effect in the region, an impact that can be attributed solely to Bolsa Familia as government spending in the health sector was static between 2000 and 2015.
Impact on Healthcare
In 2000, the life expectancy for the north-eastern region of Brazil was 66 years old. A low figure compared to the country average: 70. After the year of implementation of the BFP, life expectancy rises by two years between each time period considered. Frequent check-ups and vaccinations, encouraged by the program, have the potential to detect illness sooner and provide appropriate care, saving lives and elevating life expectancy. With better access to health and a prolonged life, people living in poverty are presented with the opportunities to enhance their human capital.
As for infant mortality rates, the region experienced an extremely high number in 2000, 43 percent. In 15 years, the rate of infant mortality decreased over 24 percentage points, an impressive rate. The BFP’s emphasis on prenatal and postpartum care and its prominence in the region imply that the rapid decrease in the rate of infant mortality is part of the program’s impact. It also evidences an increasing awareness of nutrition and the importance of immunisations, both encouraged through the program’s conditionalities.
It is common to see little change in statistics between 2000 and 2003 and the greatest fluctuations after 2010, when the BFP had been functioning for over a decade. The evidence suggests that by encouraging health care visits as conditionalities, the BFP has improved conditions that nurture development in north-eastern Brazil. The BFP has led the world of conditional cash transfers (CCT) as a successful example. However, CCTs face many challenges: critics of the program highlight the conditionality aspect as too paternalistic, and the lack of human capital-including the quality of health and education facilities- as obstacles for the programs. It is also said to be a corruption-prone policy. A focused analysis of how the BFP overcomes these issues is vital for other countries implementing CCTs.
By Giovana Cardoso
Giovana is from Brazil. Before starting her MA in Poverty and Development at IDS, she completed an undergraduate degree in Politics and International Relations. She is mainly interested in social assistance programs and the provision of quality healthcare in developing countries.