"No one says 'No' to money" - a mixed methods approach for evaluating conditional cash transfer schemes to improve girl children's status in Haryana, India.
BACKGROUND
Haryana was the first state in India to launch a conditional cash transfer (CCT) scheme in 1994. Initially it targeted all disadvantaged girls but was revised in 2005 to restrict it to second girl children of all groups. The benefit which accrued at girl attaining 18 years and subject to conditionalities of being fully immunized, studying till class 10 and remaining unmarried, was increased from about US$ 500 to US$ 2000. Using a mixed methods approach, we evaluated the implementation and possible impact of these two schemes.


METHODS
A survey was conducted among 200 randomly selected respondents of Ballabgarh Block in Haryana to assess their perceptions of girl children and related schemes. A cohort of births during this period was assembled from population database of 28 villages in this block and changes in sex ratio at birth and in immunization coverage at one year of age among boys and girls was measured. Education levels and mean age at marriage of daughters were compared with daughters-in-law from outside Haryana. In-depth interviews were conducted among district level implementers of these schemes to assess their perceptions of programs' implementation and impact. These were analyzed using a thematic approach.


RESULTS
The perceptions of girls as a liability and poor (9% to 15%) awareness of the schemes was noted. The cohort analysis showed that while there has been an improvement in the indicators studied, these were similar to those seen among the control groups. Qualitative analysis identified a "conspiracy of silence" - an underplaying of the pervasiveness of the problem coupled with a passive implementation of the program and a clash between political culture of giving subsidies and a bureaucratic approach that imposed many conditionalities and documentary needs for availing of benefits.


CONCLUSIONS
The apparent lack of impact on the societal mindset calls for a revision in the current approach of addressing a social issue by a purely conditional cash transfer program.
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India. kanandiyer@yahoo.com.
Anand
A
Krishnan
Ritvik
R
Amarchand
Peter
P
Byass
Chandrakant
C
Pandav
Nawi
N
Ng
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002662:Child Health Services / Q000191:economics*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D004522:Educational Status; D005260:Female; D006801:Humans; D007114:Immunization; D007194:India; D008393:Marriage; D011639:Public Opinion; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D063507:Sexism / Q000517:prevention & control*; D011795:Surveys and Questionnaires