Beyond 80% : Are There New Ways of Increasing Vaccination Coverage? Evaluation of CCT Programs in Mexico and Nicaragua

In recent years there has been significant global effort to scale-up immunization programs to achieve higher levels of vaccine coverage against major childhood diseases. However, coverage disparities still exist not only between, but within countries, and traditional supply-side program strategies may not be sufficient to achieve coverage goals. Conditional cash transfer programs are an innovative social assistance mechanism that provides cash transfers to poor families, conditional on their use of preventive health care services and children's regular school attendance. A primary objective of CCTs is to break the inter-generational transmission of poverty by improving the human capital of the poorest households. This study evaluates the impact of the Mexican CCT program, Oportunidades and the Nicaraguan program, Red de Protección Social, on vaccination coverage for BCG, DPT, OPV and MCV in children less than three years of age, using a randomized treatment and control design at the community level. The intent-to-treat effect on vaccination coverage is assessed using a double-difference estimator. This study found that in Mexico and Nicaragua, CCTs significantly contribute to increased vaccination coverage among children, particularly among those not reached by traditional program strategies, such as children living further from health facilities and with mothers having less than primary school. Six months after its introduction, implementation of Oportunidades in Mexico was associated with a statistically significant 5 percentage point increase in BCG coverage rates and a 3 percentage point increase in MCV coverage for on-time vaccination. Five months after the introduction of the health component in Nicaragua, the program impact led to a statistically significant increase in on-time vaccinations for OPV3 coverage (13 percentage points or 17 percent) and fully vaccinated children (20 percentage points or 37 percent). Program effects are seen in high and low coverage settings, as well as in low- and middle-income countries. CCTs need to be considered as one of the possible strategies that national immunization programs can use to strengthen vaccination coverage, particularly among hard-to-reach populations. The global immunization community needs to increase its awareness of CCTs and their possible role in achieving MDG4