Figure 3. Proposed theory of change for PROSPERA: Focused on increasing social mobility *PBGS: Basic Guaranteed Health Package Source <!-- Start of picture text --> Increase in<br>capacities<br><!-- End of picture text --> <!-- Start of picture text --> Continuous<br>school<br>attendance<br><!-- End of picture text --> <!-- Start of picture text --> Better learning<br>achievement<br>Fertility delay<br>health<br><!-- End of picture text --> <!-- Start of picture text --> $<br><!-- End of picture text --> <!-- Start of picture text --> Greater<br>availability of<br>resources<br><!-- End of picture text --> <!-- Start of picture text --> Positive<br>educational<br>mobility<br><!-- End of picture text --> <!-- Start of picture text --> Proper<br>nutrition state<br>Good health<br><!-- End of picture text --> <!-- Start of picture text --> T<br><!-- End of picture text --> <!-- Start of picture text --> Upward<br>social<br>mobility<br><!-- End of picture text --> <!-- Start of picture text --> Fertility delay<br><!-- End of picture text --> <!-- Start of picture text --> Lower risky<br>behaviors<br><!-- End of picture text --> <!-- Start of picture text --> S<br><!-- End of picture text --> <!-- Start of picture text --> Positive<br>health<br>mobility<br><!-- End of picture text --> <!-- Start of picture text --> Effective and<br>timely health<br>care<br><!-- End of picture text --> <!-- Start of picture text --> Proper<br>nutrition state<br>T<br>Nutritious<br>diet<br>M<br><!-- End of picture text --> <!-- Start of picture text --> Ceiling of<br>accountability<br><!-- End of picture text --> <!-- Start of picture text --> $ Transfers<br><!-- End of picture text --> <!-- Start of picture text --> T Workshops<br><!-- End of picture text --> <!-- Start of picture text --> S<br><!-- End of picture text --> <!-- Start of picture text --> M<br><!-- End of picture text --> <!-- Start of picture text --> PBGS*<br><!-- End of picture text --> <!-- Start of picture text --> Supplements<br><!-- End of picture text --> Short- and medium-term evaluations have documented the results chain on the initial phases of PROSPERA’s theory of change. With regard to health, the short-term evaluation carried out between 1998 and 2000 identified a 25% reduction in illness episodes among children who received support from the program during their first six months of life. These effects increased thereafter with exposure to the program. The evaluation also identified a 25% reduction in the prevalence of anemia and a 1 cm or more growth increase in children during their first year of life (Gertler, 2004; Rivera et al., 2004; Behrman and Hoddinott, 2005; Cecchini and Soares, 2015). It was estimated that this additional growth would result in a 2.9% increase in permanent income during adulthood (Behrman and Hoddinott, 2005).

Research on transfer programs has consistently shown positive effects on prenatal care, improved care during labor and delivery, reduction in low birth weight (Glassman et al., 2013), and general positive infant mortality outcomes. An ecological analysis that uses the staggered growth of the program at a municipal level in the country, identified a 17% reduction in the infant mortality rate (IMR) among the beneficiary population in rural areas, and an 8% reduction in IMR across all municipalities with program beneficiary population (Barham, 2011).

A greater use of public sector health services and reduction in the use of private health services was documented in the mid-term evaluation, which translated into lower household health expenditures. PROSPERA’s increased promotion of preventive services was accompanied by an observed reduction of two sick days annually per family for persons between 0 and 5 years of age, and a reduction of six days annually per family for persons between 16 and 49 years of age (Gutierrez, Bautista, et al., 2005). A reduction in the prevalence of overweight boys and girls was also observed (Fernald, Gertler and Neufeld, 2008 and 2009).

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