Colombian and a Jamaican program, while the remaining programs seem to have had smaller and often insignificant effects on health-care service use. An analysis of the impact of CCT programs on vaccination and immunization rates yields comparable results (Fiszbein and Schady, 2009). While some programs seem to be highly successful—in Nicaragua administrative records indicate that full vaccination coverage increased from 60 to 78 percent—others show little or no improvement. Expressed as a share of per capita consumption in participating households, the conditional transfers that trigger these effects range between 7 percent for Chile and 27 percent for Nicaragua (Red de Protección Social); Honduras and Jamaica are at the lower end with approximately 10 percent. However, these results have to be interpreted with care. While they point to the importance of demand-side factors, an assessment of their precise role would need to look more deeply into the mechanics of each specific program, especially the size of the transfer and the modalities of the conditions. In addition, a number of CCT programs have at least some supply-side components, in which case the impact evaluations show the effect of simultaneous supplyand demand-side interventions. We will return to this point later.

While health components are an important part of some CCT programs, most focus on educational achievement. The effects of the programs are clearer with regard to enrollment than for health services. Fiszbein and Schady (2009) conclude that CCT programs have had a significant positive impact on enrollment, an effect that is very large for some countries. The Red de Protección Social in Nicaragua, for example, increased enrollment by 13 percentage points from a baseline enrollment rate of 72 percent for children aged 7–13. In Ecuador, a conditional transfer of only 10 percent of per capita expenditure resulted in a 10-percentagepoint increase in enrollment of children aged 6-17 from a baseline level of 75 percent. Most remarkably, the Japan Fund for Poverty Reduction increased the enrollment of girls in grades 7–9 in Cambodia from 65 percent to more than 95 percent with a transfer volume of only 2 to 3 percent of per capita consumption (Filmer and Schady, 2008). In light of the heterogeneity of these experiences, Fiszbein and Schady (2009) conclude that the effect of transfer size seems to be highly context specific and dependent on a variety of other factors.<sup>18</sup> It is not the case, however, that these evaluation results come as a complete surprise. Rather, these programs were initiated based on evidence that schooling choices depend on a number of demand-side factors, particularly household income. Suggestive evidence again comes

> 18 In light of the importance of income, it would be interesting to know whether the first C in CCT, conditionality, really matters. A recent paper by Baird et al. (2009) that evaluates a (partly) conditional cash transfer program targeted at girls and young women in Malawi provides some evidence in this regard. The authors find that the (significant) impacts of the program were, on average, similar for conditional and unconditional payments.

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