Health Services/Policy
Impact of South African child support grant on child health: longitudinal evidence from 2008-2017 Daniel Flanagan* Daniel Flanagan Alexandria Hadd Robin Richardson
Background: Established in 1998 to improve the welfare of children living in low-income households, South Africa’s Child Support Grant (CSG) has grown to one of the largest cash transfer programs globally. Previous cross-sectional evaluations of the CSG have been limited in establishing long-term benefits on child health. Our objective was to evaluate the effect of receiving a CSG on child health outcomes using longitudinal data collected over a 10-year period.
Methods: We used data from the National Income Dynamics Survey (NIDS), which collected demographic, income, and health data on children and caregivers via repeat household surveys every two years from 2008-2017. Multivariable logistic regression was used to estimate the effect of grant receipt on three child health indicators: moderate-severe stunting (height-for-age z-score ≤ -2 SD), moderate-severe wasting (weight-for-height z-score ≤ -2 SD), and clinic visits in the past 12 months. For stunting and wasting, we restricted our sample to children <5 years old (n=8,876). For clinic visits, we included children up to 15 years old (n=18,545). Models adjusted for survey year, province, child race, and caregiver’s age, gender, education level, and employment status.
Results: 67.5% and 66.4% of eligible children under 5 and 15 years old successfully received a child support grant. In adjusted models, we found no association between grant receipt and moderate-severe stunting (OR=1.13; CI95 0.98-1.32) or moderate-severe wasting (OR=1.12; CI95 0.87-1.45). Grant receipt was associated with reduced odds of visiting a clinic in the past year (OR=0.78; CI95 0.74-0.82).
Conclusions: Among eligible children, receiving a child support grant did not reduce moderate-severe stunting or wasting in children under 5 but did reduce annual clinic visits in children 0-15 years old. Use of longitudinal data to study CSG impact improves upon prior evaluations but highlights the challenge of quantifying long-term benefits to child health.