explicit schooling conditions, 7 out of 11 report significant impacts on attendance and 3 out of 9 report significant impacts on enrollment.<sup>79</sup> This suggests that, like the results of by Baird et al, conditions may help to strengthen educational impacts of safety programs. This result is reinforced by two studies on programs with both conditional and unconditional components: the Malawi’s Zomba Cash Transfer Program Pilot found the strongly enforced conditional cash transfer (CCT) arm obtained a large gain in enrollment and a modest yet significant advantage in learning, and the Burkina Faso Nahouri Cash Transfers Pilot Project found that CCTs had a greater impacts than unconditional cash transfers (UCTs) for targeting marginal children not enrolled already in school or less likely to enroll, and an greater impact attendance for all children.<sup>80</sup> The other study, Zimbabwe’s HIV Prevention Project, found similar positive significant impacts for both UCTs and CCTs on school attendance.

Conditions, however, may not always be appropriate for programs in Africa. For example, if access to education is not guaranteed or if monitoring and enforcing conditions would be inefficiently expensive. In these situations, programs may wish to consider ‘implicit conditoinality’ (Pellerano et al., 2014; Schuring, 2010), as there is evidence that perceptions of conditions (Schady and Araujo, 2006) and encouragement of certain behaviors and service use (Benhassine et al., 2013) can influence program outcomes. Evidence from the programs covered in this review appear to strongly support this conclusion. Four of 17 programs covered in the meta‐analysis are designed in such a way that beneficiaries perceive that the transfer is conditional on a certain behavior.<sup>81</sup> Three of these programs reported statistically significant results in increasing enrollment or attendance.<sup>82</sup> This was achieved through strong messaging and social marketing. Notably, unlike the programs with strongly enforced conditions, each of these programs have advanced towards cash transfers scaled up at the national level. Thus, there may be institutional characteristics to consider when using CCTs in a low‐income setting like Africa. Pellerano et al. (2014) elaborate on this point, suggesting that the feasibility of conditioning will depend on the adequacy of public services, scale‐up capacity, cost‐effectiveness of ‘explicit’ conditionalities, and political feasibility.

The meta‐analysis is more limited concerning health outcomes, reflecting both the demand and supply side constraints and the speed at which program impacts can be realized. Our meta‐analysis found 9 studies reporting on healthcare expenditures, with a mean effect of 13% increase in monthly spending but this result was not significant [95% CI: ‐23% to 48%].<sup>83</sup> Studies finding positive impacts include Kenya’s HSNP and Zambia’s CGP. In Kenya’s HSNP, the evaluation notes that households spend more on health per capita without negative impacts on food consumption or asset retention.<sup>84</sup> In Zambia, approximately 5% of transfers are related to health and hygiene, and there is some evidence of impact on young children

> 79 Here we report significance at 10%‐level as significant.

> 80 Baird et al (2011), Akresh et al (2013).

> 81 Lesotho’s Child Grant Program, Malawi’s Social Cash Transfer, Niger’s Safety Net Project, Zambia’s Child Grant Program.

82 Not surprisingly, Niger’s Safety Net Project did not result in significant primary educational outcomes, because it focused on early childhood development, and children under the age of 5.

83 Sources: Ward et al. 2010 (Kenya CTOVC), Evans et al. 2014 (Tanzania CB‐CCT), Pellerano et al. 2014 (Lesotho LCGP), Seidenfeld et al. 2013 (Zambia ZCGP), Merttens et al. (2013), Rosas and Sabarwal 2016 (Sierra Leone CFW), Haushofer and Shapiro 2016 (Kenya GIVE), Premand and Del Ninno 2016 (Niger NSNP), Abdoulayi et al. 2015 (Malawi SCTP).

84 Merttens et al. 2013 (Kenya HSNP).

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