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72506

Program Keluarga Harapan
Main Findings from the Impact Evaluation of Indonesia’s Pilot Household Conditional Cash Transfer Program

Public Disclosure Authorized

Public Disclosure Authorized

World Bank Office Jakarta June 2011

Acknowledgments
This report was prepared by the Poverty Team, part of the Poverty Reduction and Economic Management (PREM) group in the World Bank Office Jakarta. Vivi Alatas, the Task Team Leader, led the analytical activities and oversaw the preparation of the report. She was supported by a team that included: Nur Cahyadi, Elisabeth Yunita Ekasari, Sarah Harmoun, Budi Hidayat, Edgar Janz, Jon Jellema, Hendratno Tuhiman, and Matthew Wai-Poi. The University of Gadjah Mada (UGM), Center for Public Policy Studies, implemented the baseline and final survey. The analysis for this evaluation was based on survey data that was collected and processed by some 860 enumerators and researchers. The survey work was led and overseen by Susan Wong. This report also draws from the findings of the resulting 2007 baseline survey report written by Robert Sparrow, Jossy Moeis, Arie Damayanti and Yulia Herawati. The Center for Health Research at the University of Indonesia, with the support of partner universities across the country, prepared a report in 2010 on the implementation of Program Keluarga Harapan (PKH), based on qualitative and quantitative spot-checks of the program. In addition, SMERU, an independent research organization in Indonesia, provided complementary qualitative studies in 2007 and 2009. These excellent reports have contributed to efforts to better understand how PKH works and contribute to reform efforts. Their work complements the findings from this impact evaluation, providing inputs for policy makers responsible for oversight and expansion of the program. Financial support for the survey comes from the Government of Indonesia, the Royal Embassy of the Netherlands, the World Bank, and the World Bank PNPM Support Facility, which is supported by the governments of Australia, the United Kingdom, the Netherlands, and Denmark, as well as a contribution from the Spanish Impact Evaluation Fund. Peer reviewers were: Emanuela Galasso, Margaret Grosh, Joppe Jaitze De Ree, and Rebekah Pinto. This report also benefited from valuable comments from Benjamin Olken (M.I.T., Department of Economics) and Susan Wong. The Government of Indonesia has provided excellent leadership in designing and implementing PKH. The National Development Planning Agency (Bappenas) has been instrumental in overseeing the development of the pilot and assessing its implementation, which was carried out by the Ministry of Social Affairs (Kemensos) and the national postal agency, PT Pos. The Secretariat for the National Team for the Acceleration of Poverty Reduction (Tim Nasional Percepatan Penggulangan Kemiskinan, TNP2K) has played an important role in providing policy leadership for program improvements and expansion. Special thanks to: Prasetijono Widjojo and Pungky Sumadi, Rudy Prawiradinata, Endah Murniningtyas, Vivi Yuliswati, Woro S. Sulistyaningrum, Arum, Srihartati, Pungkas Baijuri Ali (Bappenas); Sujana Royat (Kemenkokesra); Akifah Elansary, Gaol Lumban, Heru Sukoco (Kemensos); Wynandin Imawan (BPS); Bambang Widianto (TNP2K Secretariat).

The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors, or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use.

Table of Contents
Acknowledgements Table of contents ………………………………………………………………………………………………………………………………….. ii Abbreviations, Acronyms and Terms .......................................................................................................... iv Executive Summary ……………………………………………………………………………………………………………………………. 6 Chapter 1 Introduction ……………………………………………………………………………………………………………………… 9 Chapter 2 I. II. III. IV. V. VI. Chapter 3 I. II. III. IV. V. Program Design …………………………………………………………………………………………………………………. 10 Program Background ………………………………………………………………………………………………………… 10 Program Objectives ………………………………………………………………………………………………………….. 11 Geographic Targeting ……………………………………………………………………………………………………….. 14 Beneficiary Selection ………………………………………………………………………………………………………… 17 Transfer Delivery and Verification Mechanism …………………………………………………………………. 17 Complementary Programs …………………………………………………………………………………………………19 Program Implementation Assessment ………………………………………………………………………………. 21 Program Socialization ………………………………………………………………………………………………………. 21 Verification Systems …………………………………………………………………………………………………………. 21 Adequacy and Timing of Payments……………………………………………………………………………………. 22 Inter-Agency Coordination ………………………………………………………………………………………………. 23 Improvements in Implementation ……………………………………………………………………………………. 24

Chapter 4 Program Evaluation Design …………………………………………………………………………………………………..25 I. Evaluation Indicators ………………………………………………………………………………………………………….25 II. Sample Construction ………………………………………………………………………………………………………… 26 III. Data Sources …………………………………………………………………………………………………………………….. 29 IV. Methodology ……………………………………………………………………………………………………………………. 31 Chapter 5 Main Results ………………………………………………………………………………………………………………………..32 I. Household Welfare……………………………………………………………………………………………………………. 32 II. Health Behaviours and Outcomes …………………………………………………………………………………….. 32 III. Education & Child Labor …………………………………………………………………………………………………… 34 IV. Disaggregated Results ………………………………………………………………………………………………………. 35 Chapter 6 Program Cost effectiveness ………………………………………………………………………………………………… 39 Chapter 7 Recommendation ……………………………………………………………………………………………………………….. 41 References ………………………………………………………………………………………………………………………………………….. 43 Annex A: Indicator Definitions …………………………………………………………………………………………………………….. 45 ii

Annex B: Baseline Balance Test Results ………..…………………..……………………………………………………………….. 47 Annex C: Propensity Score Matching ………………………………….………………………………………………………………. 60 Annex D: Methodology …………………………………………………………………………..…………………………………………… 64 Annex E: Main Results ………………………………………..……………………………………………………………………………….. 75 Annex F: Robustness Check …………………………………………………………..………………………………………….…………. 83 Annex G: Disaggregated Results …………………………………………………………..……………………………………………… 87

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Acronyms, Abbreviations & Indonesian Terms
ARI Askeskin Bappenas Bidan BLT BOK BOS BPS BULOG CCT Desa DKI DPT Dusun GOI IP Jamkesmas JSLU JSPACA Kabupaten KDP Kecamatan Kelurahan Kemdiknas Kemenag Kemenkes Kemenkokesra Acute respiratory infection Asuransi Kesehatan Miskin (Health Insurance for the Poor) Badan Perencanaan dan Pembangunan Nasional (National Development Planning Agency) Mid-wife Bantuan Langsung Tunai (unconditional cash transfer program) Bantuan Operational Kesehatan (Operational Health Assistance Program) Bantuan Operasional Sekolah (School’s Aid Program) Badan Pusat Statistik (Statistics Indonesia) Badan Urusan Logistik (Logistic Agency) Conditional cash transfer Village Daerah Khusus Ibukota (Special Capital Territory) Diphtheria, pertussis (whooping cough) and tetanus Rural ward (sub-village) Government of Indonesia Infrastruktur Pedesaan (Rural Infrastructure Program) Jaminan Kesehatan Masyarakat (health insurance scheme for the population) Jaminan Sosial Lanjut Usia (social cash transfer for the elderly) Jaminan Social Penyandang Cacat Berat (Social cash transfer for the disabled) District Kecamatan Development Project Sub-district Urban precinct Kementerian Pendidikan Nasional (Ministry of National Education) Kementerian Agama (Ministry of Religious Affairs) Kementerian Kesehatan (Ministry of Health) Kementerian Koordinator Kesejahteraan Rakyat (Coordinating Ministry for Social Welfare)

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Kemenkominfo Kemensos MDG MIS NTT PAM PKH PKPS-BBM PKSA PLN PMT PNPM-Generasi PNPM-Mandiri PODES Posyandu PPLS PT Pos Puskesmas Raskin Rp RPJMN RTSM SD SMP TNP2K UGM UPP UPPKH

Kementerian Komunikasi dan Informatika (Ministry of Communications and Information Technology) Kementerian Sosial (Ministry of Social Affairs) Millennium Development Goals Management Information System Nusa Tenggara Timur (East Nusa Tenggara province) Perusahaan Air Minum (public water utility) Program Keluarga Harapan (Hopeful Family Program) Program Kompensasi Pengurangan Subsidi Bahan Bakar Minyak (compensation program for the reduction of oil energy subsidies) Program Kesejahteraan Sosial Anak (children’s social welfare program) Perusahaan Listrik Negara (State Electricity Company) Proxy-means test PNPM Generasi Sehat dan Cerdas (PNPM Healthy and Smart Generation Program) Program Nasional Penberdayaan Masyarakat Mandiri (National Community Empowerment Program) Potensi Desa (Village Potential Statistics) Pos Pelayanan Kesehatan Terpadu (Integrated [health] service post) Pendataan Program Perlindungan Sosial (Data collection for [targeting] social protection programs National post office Pusat Kesehatan Masyarakat (community health center) Beras Miskin (program for sale of subsidized rice for the poor) Indonesian Rupiah Rencana Pembangunan Jangka Menengah (national medium-term development plan) Rumah Tangga Sangat Miskin (extremely poor households) Sekolah Dasar (primary school) Sekolah Menengah Pertama (junior secondary school) Tim Nasional Percepatan Penanggulangan Kemiskinan (National Team for the Acceleration of Poverty Reduction) University of Gadjah Mada Urban Poverty Program Unit Pelaksana Program Keluarga Harapan (PKH Implementation Unit)

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Executive Summary
In 2007, the Government of Indonesia launched its first household-based conditional cash transfer program: Program Keluarga Harapan (PKH, or the Hopeful Family Program). The program is intended to improve the welfare of extremely poor households by providing them with quarterly cash transfers ranging from Rp 200,000 to Rp 600,000 per quarter. At the same time, the program is designed to break the transmission of poverty to next generations by encouraging families to increase their use of public services to, over time, improve the health and education outcomes of their children. It does this by providing the transfer only to households with pregnant women and/or children, provided that they fulfill specific health and education-related obligations. The implementing agency, the Ministry of Social Affairs (Kementerian Sosial, Kemensos) initially provided benefits to 432,000 “extremely poor” households in 7 provinces. PKH represents a new generation of social assistance programs that incorporate rigorous monitoring and evaluation methods into program design from the beginning. Treatment sub-districts (kecamatan) were randomly selected for participation in the PKH pilot, making it possible to measure the program’s impact by comparing behaviors and outcomes with households that did not receive cash transfers. A baseline household survey in participating (treatment) and non-participating (control) kecamatan was conducted in 2007. The same households were surveyed again in 2009, producing a full panel of data that was used to evaluate the program’s impact. The evaluation found that PKH was effective in terms of improving the welfare of beneficiary households. Their average monthly expenditures increased by Rp 19,000 per person, equal to a 10 percent increase in comparison to pre-program levels. Households used this additional income to increase their spending on food (especially high-protein foods) and health costs. There is no evidence that beneficiaries misspent the additional funds on non-productive goods such as tobacco or alcohol. The program also demonstrated a positive impact on helping households to increase their usage of primary healthcare services. The likelihood of mothers from beneficiary households completing four pre-natal check-ups increased by more than 13 percent above pre-program levels, and completing the recommended two post-natal visits increased by nearly 21 percent. The likelihood of children (ages zero to 5 year olds) being taken to local health facilities to be weighed increased by 30 percent above baseline levels. At the same time, beneficiary households increased the likelihood of completing their children’s vaccinations by approximately 11 percent. Increased usage of health services also contributed to an increase in the share of households that treated their children for diarrhoea by 13 percent. Beneficiary households, however, did not demonstrate increased usage of recommended vitamins (iron tablets for pregnant women or vitamin A for children), which is partly due to insufficient stocks. There is no evidence yet of changes in long-term health outcomes – such as child malnutrition and mortality rates – which are not expected to be observed over the short timeframe of the three-year survey. The benefits of the program also extended to neighbouring households that did not receive cash transfers but nevertheless changed their behaviours (i.e., a “spill-over effect”). Their pre-natal visits increased by over 6 percent compared to pre-program levels and child weighings increased by 10 percent compared to pre-program levels. Changes among these neighboring households may have been encouraged by the positive example of beneficiaries as well as PKH facilitators who played an important role in helping to spread information about healthy behaviours. 6

The pilot program had little impact on changing education behaviors. For children from beneficiary households who were already in school, the program helped to increase the time they spent in school. Junior secondary students spent approximately 40 minutes more in school per week, while primary school students spent 20 more minutes per week. During the initial pilot phase, however, PKH had no impact on drawing more children into the education system and keeping them in school. Enrolment rates, drop-out rates, and the incidence of wage labor remained unchanged after three years. This is likely because the quarterly cash transfers were too late and too little. Payments did not coincide with the academic school year, so parents did not have the funds when needed. Also, the amount received was not adequate to cover additional fees that parents must usually pay, especially for junior secondary school.1 PKH is a cost-effective program due to limited leakage of benefits and reasonable overhead costs. Program administrative costs – averaging approximately Rp 200,000 per beneficiary per year – accounted for 14 percent of total spending in 2008 and 2009. This is down from 17 percent during the first year of implementation, which involved greater “start up” costs, especially related to capital spending. These costs are moderate in comparison with other cash transfer programs in Indonesia, and compare relatively well to CCT programs in other countries. As the program goes national, average administrative costs could be expected to further decline. Because of early implementation difficulties and delays in some crucial processes, the evaluation results presented herein do not represent impact estimates from a well-implemented conditional cash transfer and therefore they may be underestimates. In particular, information dissemination was limited, resulting in low levels of awareness among village officials and local service providers. Also, during the first two years compliance verification systems were not fully functional, resulting in few (if any) penalties for households that did not comply with program conditions. A management information system was not operational, contributing the delays in payment deliveries. Although sub-districts (kecamatan) included in the pilot were deemed to have sufficient supply of health and education facilities, households in rural areas faced difficulties in accessing community health centers and junior secondary high schools. Approximately 10 percent of surveyed health centers did not have readily available stocks of vaccinations or appropriately stored vitamin supplies. Since the launching of PKH, however, there have been continuous improvements in the systems that support implementation of the program. The management information system and compliance verification system, for example, are now functional. As of late 2010, over 85 percent of households were captured in the compliance verification system (a component of the MIS system). Also, changes in implementation procedures address some of the problems flagged by the recent assessments. For example, the payment schedule is now synchronized with the academic year. With these changes, the impact of the program in encouraging positive health and education behaviors is expected to be greater. PKH has emerged as one of the government’s key social assistance programs. As of 2010, the program has expanded to reach 810,000 households across 13 provinces. According to the current national medium-term development plan (RPJMN), the program will be doubled to reach more than 1.5 million poor households by 2012. The Government of Indonesia is currently considering expanding coverage to 3 million households by 2014. Before this expansion continues, there is a need to clarify the role of PKH
1

On average, the costs of junior secondary schooling for households in the poorest quintile equals 25 percent of per capita consumption, less than the PKH cash transfer that is equal to 15-20 percent of per capita consumption.

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in the integrated social safety net that Indonesia is starting to develop. Also, as the program expands there is still room for improvements in the design and implementation of the program to maximize its impact. To this end, the following lessons learned and recommendations are proposed: 1. Continue to target all chronic poor in Indonesia during the expansion, while developing a lighter version of the program for eligible households located in supply-deficient areas. Not all areas with chronic poor will meet all supply-side criteria; in such areas, a preparatory PKH program with minimal and affordable conditions can provide an introduction to the principles of a conditioned cash transfer, the program’s facilitators, service providers, and household responsibilities. Crossgovernment efforts should focus on improving health and education facilities in “supply poor” areas, which may include innovative programs such as the community-based block grant program, PNPMGenerasi. When the supply of services catches up, households should graduate to regular PKH. 2. Re-design benefits to improve PKH’s impacts on drawing children into the education system and keeping them in school. Disbursements should arrive shortly before school fees are assessed while payments for meeting education conditions need to be revised upward to meet the total costs of education. Payments need not be of equal size; consider providing a greater share of the annual transfer amount before school fees are due. Financial rewards for successfully completing the primary-to-secondary school transition as well as increased facilitator outreach to dropouts can increase PKH’s effectiveness during the risky transition phase. 3. Continuously improve program implementation and strengthen coordination among all relevant agencies. Implementation studies show roadblocks in the PKH implementation process (for example, compliance verification forms not been delivered on time) can lead to further delays (for example, in payment disbursement) which diminish the positive household impacts of the program. The PKH program will not run at peak effectiveness and efficiency until all agencies have improved coordination and can reliably deliver the right amount of assistance when it is needed. PKH’s sophisticated MIS system also requires inter-agency coordination and a common understanding of the system’s capabilities and its role in the continuous program reform cycle. 4. Maximize impact by ensuring that all social assistance programs work in concert to protect the most vulnerable. Currently it is unlikely that PKH households will receive all complementary services and programs like Jamkesmas (the health service fee waiver), Raskin (the subsidized rice program), or the education ministry’s scholarship program (for PKH students who continue on to senior secondary education) even though they are eligible. GOI efforts to establish a unified national registry will jumpstart the coordinated approach to targeting the most vulnerable with a set of complementary initiatives. In the future, PKH facilitators should be responsible for checking that PKH households receive all benefits to which they are entitled and provide remedies for households who may have been left out. 5. Prepare for future rounds of implementation assessments and household surveys to track progress. Implementation assessments are instrumental in ensuring continued progress towards implementing reforms and improving program performance. Budget and prepare for future followup survey to assess the impact of PKH on long-term outcomes including child and maternal mortality rates, and school transition rates. Future studies can incorporate piloting and testing the additional benefits of complementary activities, such as awareness programs that help parents to understand the benefits and recommended practices for vitamins, natal visits, child weighing and vaccinations.

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1

Introduction

Household conditional cash transfer (CCT) programs offer countries a new way to tackle poverty and prevent the transmission of poverty to future generations. They do so by providing regular cash payments to families on the condition that they fulfill basic obligations, which are typically related to the usage of health and education services. The Government of Indonesia launched its own household conditional cash transfer program, Program Keluarga Harapan (PKH or Hopeful Family Program), in order to improve lagging health and education outcomes among extremely poor households. The program delivers quarterly cash transfers to very poor households with children or lactating/pregnant women provided that they fulfill a range of health and education-related obligations. When the pilot program first began in 2007, cash transfers were delivered to over 300,000 poor households in 7 provinces. Since then, PKH has expanded to over 700,000 households and is now active in 13 provinces.3 PKH has emerged as one of the government’s strategies to reduce poverty and reach its Millennium Development Goals (MDGs). The Government of Indonesia is currently considering expanding coverage to 3 million households by 2014. The government is also piloting other innovative approaches, including a complementary community conditional cash transfer program – PNPM Generasi Sehat dan Cerdas (Generasi, or Healthy and Smart Generation Program) – that was piloted and evaluated alongside PKH. Programs such as PKH and PNPM Generasi stand apart from earlier generations of poverty reduction programs in that rigorous monitoring and evaluation methods were incorporated into the programs’ design from the beginning. Both pilots randomized sub-district participation into the design of the program, making it possible to directly measure program impact. A baseline survey of participating (treatment) and non-participating (control) sub-districts and households was conducted in 2007. Spot checks were carried out in 2009 to assess the implementation, institutions, and processes of the PKH program. Another survey was conducted during late 2009 to collect data for the final impact evaluation of both programs. This has provided powerful data and information for the government and its development partners to assess the effectiveness of the program and resolve problems with design and implementation before the programs are scaled up. This report presents the main findings from the impact evaluation of the PKH pilot. Chapter 2 describes the design of the household CCT program and a description of quality of implementation at the time of the impact evaluation. Chapter 3 summarizes the findings from the implementation assessments of the pilot. Chapter 4 reviews the design of the impact evaluation and provides an explanation about the research methodologies used. The main findings of the evaluation are presented in Chapter 5. Chapter 6 presents a brief analysis of the costs of implementing the PKH program and PKH’s cost-effectiveness. Finally, Section 7 provides recommendations to policy-makers, applying findings from the evaluation to formulate next steps that should be considered during the planned expansion of the program. Results from this impact evaluation are also included also in the PKH background chapter of the “Indonesia Household Social Assistance Public Expenditure and Program Review”, which is a larger report analyzing the effectiveness, implementation success, and efficiency of all GOI household-based social assistance initiatives – see World Bank (2011b) and World Bank (2011c) for the report and background chapter respectively.

3

Based on PKH administrative data (Kemensos, 2010) the program reached 703,338 households in 13 provinces as of February 2011.

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2
2.1

Program Design
Program Background

In response to climbing world oil prices in 2005, the Government of Indonesia decided to cut domestic fuel subsidies to stem major fiscal losses. They also decided to apply some of the savings from the subsidy reduction to social assistance programs with the intention to mitigate the negative effects of fuel price increase for poor and vulnerable households. This fuel subsidy compensation scheme (Program Kompensasi Pengurangan Subsidi Bahan Bakar Minyak, PKPS-BBM) included: health insurance for the poor (Asuransi Kesehatan Miskin, Askeskin); rural infrastructure program (Infrastruktur Pedesaan, IP); a school aid program (Bantuan Operasional Sekolah, BOS); and a temporary unconditional cash transfer program (Bantuan Langsung Tunai, BLT). This was the first national, large-scale cash transfer program to be implemented in Indonesia. The BLT program reached approximately 19.1 million households in 2005, and provided approximately US$120 in four installments over a one-year period. Opponents of the program, however, criticized the targeting of the program. The program cast a wide safety net and transferred a significant portion of the program benefits to households that, though vulnerable, were above the poverty line.4 They also criticized the program based on the assumption that cash handouts would create dependency on the government and provide an incentive for poor households to work less. Many also feared that providing an unconditional transfer, with little monitoring of the usage of funds, would make it more likely that recipients would misspend the additional income on non-productive goods like tobacco or alcohol.5 In September 2006, the program drew to a close as planned; the other PKPS-BBM programs continued and formed the core of the government’s households-centered social assistance programs. Despite sustained economic growth and the launching of social assistance and other poverty reduction programs, Indonesia’s human development outcomes among the poor remained a cause for concern. Maternal mortality rates were among the highest in Southeast Asia; for every 100,000 live births about 228 women died.6 Infant mortality and children-under-five mortality rates also remained much higher than in neighboring countries.7; the prevalence of underweight children under the age of five was estimated to be 18.4 percent in 2007.8 Many children were dropping out or did not continue from primary to junior secondary school; while primary school enrolment rates were 94 percent, junior secondary enrolment rates were only 65 percent.9 Policy makers responded by designing a new generation of social assistance programs that were better designed and targeted to provide assistance to poor families and communities, and ensure that future generations can escape poverty. These
4

High inclusion errors were partly the result of quickly compiling a beneficiary list so that benefits could be delivered in time to buffer households from the price increase shock. 5 The World Bank has reviewed and assessed the performance of the BLT program in light of these criticisms. The findings are available in “Social Safety Nets Indonesia: Bantuan Langsung Tunai (BLT) Temporary Unconditional Cash Transfer.” Jakarta, Indonesia: World Bank 2010a (Forthcoming). The document is one of a series of policy notes summarizing current issues in the major household-targeted social assistance interventions launched by the Government of Indonesia. Also see the World Bank’s “Targeting Effectiveness of Current Social Assistance Programs in Indonesia” that includes an assessment of the targeting performance of two rounds of BLT. The policy note is part of the Targeting in Indonesia Policy Paper Series that aims to examine all elements of a national targeting system in Indonesia, which will involve assessing the effectiveness of different targeting methods, mapping the most effective method to different targeting objectives, assessing the institutional, fiscal, political, social and capacity constraints facing targeting in Indonesia, and recommending implementation strategies. 6 Indonesia Demographic and Health Survey, 2007 (Government of Indonesia). 7 World Development Indicators, 2009. Comparison countries include: Malaysia, Philippines, Sri Lanka, Thailand, and Vietnam. 8 Basic Health Research, 2007 (Government of Indonesia). 9 World Bank, 2006.

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showcased two conditional cash transfer programs: one community-based (PNPM Generasi Sehat dan Cerdas, or Generasi) and the other household-based (PKH).

2.2

Program Objectives

Household conditional cash transfer programs offer countries a new way to tackle poverty. These programs provide cash disbursements to families that fulfill basic obligations, which are typically related to increased usage of health and education services. By providing a financial incentive for families, the program contributes to improving short-term poverty alleviation. At the same time, in order to continue receiving the cash transfer, households must commit to improving preventative health care practices and increasing education enrollment rates. These investments in the family’s human capital contribute to breaking inter-generational poverty by improving health and education outcomes for children to equip them for better opportunities in the future. Two particularly successful models – the Bolsa Familia program in Brazil and the Progresa program in Mexico – triggered a replication of similar programs in Latin America, which has spread throughout the world. While country-by-country experience has varied, impact evaluations have largely concurred that CCT programs have generally been successful in increasing household consumption and decreasing poverty.10 These success stories inspired the Government of Indonesia to introduce and pilot PKH as a complement to the other social assistance and community development programs included in the national poverty reduction strategy. In addition to boosting household consumption, evaluations of CCTs generally find that these programs have also had a positive effect on increasing use of health and education services. Virtually every program that has been credibly evaluated has found a positive effect on school enrolment and some have found increased usage of health facilities.11 The evidence on final health and education outcomes, however, is mixed. International evidence has shown that although CCTs have increased the likelihood that households will take their children for preventative health check-ups, only in some cases has this be shown to improve child nutritional status among beneficiary households. Similarly, school enrollment rates have generally increased among program beneficiaries but there is less evidence that this has led to improvements in learning outcomes. The overall aims of PKH are similar to CCT programs in other countries. The main overall objectives of Indonesia’s program are: a) to reduce current poverty and b) to improve the quality of human resources among poor households. The government also identified four specific program objectives: (i) improving the socio-economic conditions of the poorest households, (ii) improving the educational level of children; (iii) improving the health and nutritional status of pregnant women, post-partum mothers, and children under 6 years in the poorest households; and (iv) improving the access to and quality of education and health services, especially for the poorest households. With these ends in mind, PKH is expected to also contribute to progress towards achievement of six of the eight MDGs.12
10

Fiszbein and Schady, 2009. The policy research report, drawing on evaluation findings from around the world, finds that CCTs have had, by and large, positive effects on household consumption and poverty (as measured by the headcount index, the poverty gap, or the squared poverty gap). They also report that CCTs have led to significant (and, in some cases, substantial) increases in the use of health and education services. 11 Fiszbein and Schady, 2009. The authors note that these positive education effects in CCT evaluation results are sometimes found among some age groups and not others. 12 For this reason, the duration of the program was initially planned until 2015, which coincides with the timeframe for achievement of the MDGs.

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Beneficiary households are intended to stay in the program for a period of approximately two to four years. By the end of this time, the program aims to achieve improvements in the following welfare and human development indicators:13 a. b. c. d. e. f. Reductions in the poverty level of beneficiary households; Reductions in child malnutrition levels; Increases in the consumption of high-energy and high-protein foods; Increases in the average education attainment level among children; Increases in the attendance rate of children from beneficiary households; and, Reductions in the number of child working hours or work participation rates among children.

13

See Table 2.1 for a full list of PKH’s success indicators. In addition, the Government of Indonesia also identified a series of general program performance indicators. For example, at least 60 percent of program benefits are intended to reach the poorest 20 percent of the population.

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Table 2.1

PKH Success Indicators

Welfare Objective: Household economy of poor families improved. 1. Per capita annual total household expenditures increased relatively by 13% 2. Share of food expenditures in the household budget increased by 4 percentage points 3. Expenditure on nutrient dense foods (meat, fruit and vegetables) increased relatively by 2% 4. The decrease in household poverty levels of PKH participants after 2 to 4 years of program implementation. 5. Decline in poor nutritional status for children under five after 2 to 4 years of the program.

Health Objective: Increased access to and utilization of health services by poor pre-school aged children, pregnant and breast-feeding mothers. 1. Percent of women who receive at least four prenatal care visits increased by 10 percentage points 2. Percentage of pregnant women with at least two doses of tetanus toxoid vaccine increased by 10 percentage points 3. Percentage of pregnant women who receive at least 12 sachets of Iron tablets increase by 10 percentage points 4. Percentage of deliveries assisted by trained professionals increase by 10 percentage points 5. Percentage of mothers and infants who receive postnatal care at least two times increase by 10 percentage points 6. DPT3 coverage (proportion children age 12-23 months who received three doses of DPT) increased by 10 percentage points 7. Measles coverage (proportion of children age 12-23 months who were immunized with measles vaccine before age 12 months) increased by 10 percentage points 8. Fully immunized child coverage (among 12-23 months olds immunized before age 12 months) increased by 10 percentage points 9. Percentage of children under five who have received 2 vitamin A capsules in the past 12 months increases by 10 percentage points 10. Percent of children age 0-3 taken to health control and weighed in the last month increased by 15 percentage points 11. Percentage of infants with monthly weights increasing appropriately (monthly increase of >500g for under 6 months and >300g for 6-11 month olds) increased by 10 percentage points

Education Objective: Use of education by poor school aged children increased. 1. Primary school (SD) gross enrollment of children 7 to 12 years old increased by 5 percentage points 2. Middle school (SMP) gross enrollment of children 13 to 15 years old increased by 10 percentage points 3. Attendance of children enrolled in primary school increased by 10 percentage points. 4. Attendance of children enrolled in middle school increased by 10 percentage points. 5. Drop-out rate decreased by 5 percentage points 6. Class repetition rate decreased by 5 percentage points 7. Increasing of the average length of school of the children coming from poor families after 2 to 4 years program implementation. 8. Decreasing the number of working hours or no more children working after 2 to 4 years of program implementation.

Targeting Performance: At least 60% of the program’s benefit enjoyed by 20% of the poor.
Source: Government of Indonesia, Ministry of Social Affairs (Kemensos)

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2.3

Geographic Targeting

The government piloted and tested Program Keluarga Harapan and PNPM-Generasi in six provinces and the city of Jakarta. In the trial stage, the conditional cash transfer pilots were implemented in five common provinces: West Java, East Java, North Sulawesi, Gorontalo, East Nusa Tenggara (NTT). PKH was implemented in an additional two regions: West Sumatra and DKI Jakarta. The provinces were selected based on their willingness to participate in the pilot, and extent to which they represented Indonesia’s diversity. The final selection for the pilot includes provinces with varying characteristics: high/medium/low poverty rates, both urban and rural areas, coastal areas and islands, and areas that are both highly accessible and difficult to access.14 Within each province, the richest 20 percent of districts (kabupaten) were excluded from both CCT programs. The ranking was based on district poverty rates, incidence of malnutrition, and transition rates from primary to secondary schooling. Districts receiving the rural community-driven development project (Kecamatan Development Program, KDP – the precursor to PNPM Rural) were eligible for Generasi. From these, 20 were selected for participation in Generasi and stratified by province. All eligible districts in Gorontalo and North Sulawesi were selected, while in NTT, East Java and West Java selection was randomized.15 PKH eligible districts were drawn from the remaining pool of districts, as well as eligible districts in West Sumatra and DKI Jakarta. For this reason, there was no overlap between the two programs. Furthermore, the PKH targeted districts tend to be more Java-based than PNPMGenerasi, which was concentrated in Sulawesi and NTT. In total, 49 districts and cities were considered eligible for PKH (Figure 2.1). Sub-districts that were considered “supply-side ready” were randomly selected to participate in the program. Readiness was determined by a statistical analysis of existing health and education facilities and providers (Figure 2.2).16 The threshold for readiness criteria was set at a lower level for sub-districts (kecamatan) off-Java, which tend to have a more limited supply of health and education services than for sub-districts on Java. This was done to ensure greater inclusion of off-Java sub-districts in the pilot program. Based on the application of these criteria, a total of 588 sub-districts were selected for participation in the pilot program. Sub-districts were then randomly assigned for participation in the pilot program. In the end, 259 sub-districts were included in the PKH treatment groups (Figures 2.1). The remaining 329 sub-districts were retained as control groups. The majority of PKH-eligible sub-districts (both treatment and control areas) were on Java. The remainder was split, almost equally, between NTT and Sulawesi. During early 2008, the government rolled out the program in the following six areas: Nanggroe Aceh Darussalam, North Sumatra, Banten, South Kalimanten, West Nusa Tenggara, and the Yogyakarta Special Region. The government plans to continue expanding this program in the future to cover all provinces and cities in Indonesia.

14 15

World Bank, 2008 (Sparrow et al.). World Bank, 2008 (Sparrow et al.). Within the selected districts, sub-districts were not eligible for PNPM Generasi if they had participated in the Urban Poverty Program (UPP) or where less than 30 percent of the villages (desa) and urban precincts (keluruhan) are considered as rural by Statistics Indonesia (BPS). This final screening yielded 300 PNPM Generasi eligible sub-districts, which were randomly assigned to incentivized treatment, non-incentivized treatment, and the control group. Randomization was stratified by district. 16 World Bank, 2008 (Sparrow et al.). Data to determine supply-side readiness was drawn from the Village Potential Statistics (PODES), a Statistics Indonesia survey that provides information about village characteristics for all of Indonesia, with a sample size of approximately 65,000 villages.

14

Figure 2.1

Map of Districts Piloting the Household Conditional Cash Transfer Program

Note: World Bank, based on data from the Ministry of Social Welfare (Kemensos)

15

Figure 2.2

Area selection and sub-district randomization

i) Provincial government willingness ii) Representation of diverse characteristics

80% poorest districts (based on transition rate, malnutrition rate, poverty rate)

KDP districts in 5 PNPM provinces

Districts selected for PNPM-Generasi: all in Gorontalo and N. Sulawesi, random in other areas Districts not selected for PNPM-Generasi

Sub-district not supply ready

Randomization:
PKH treatment group: Intention-to-treat Randomly select 329 sub-districts for PKH (until provincial quota is filled) PKH control group: Randomly select 259 sub-districts

i)

20% richest districts (based on transition rate, malnutrition rate, poverty rate)

Non-KDP eligible districts in 5 PNPM provinces ii) Districts in DKI Jakarta and West Sumatra

Sub-district supply ready

Sub-district not supply ready

Provincial
Based on: Sparrow et al., World Bank 2008.

District

Sub-district

16

2.4

Beneficiary Selection

Program Keluarga Harapan targeted households classified as extremely poor (Rumah Tangga Sangat Miskin, RTSM) by Statistics Indonesia using both economic and asset-based poverty measurements.17 To create the initial beneficiary roster, Statistics Indonesia first surveyed poor and extremely poor households, which were drawn from the 2005 BLT beneficiaries list (known as PPLS05). Approximately 30-40 percent of BLT beneficiaries were not included in the resulting roster. To minimize exclusion errors they also conducted “sweepings” in targeted sub-districts, which involved interviewing poor households with the intent to identify newly poor households that were not included in PPLS05. The sweeping exercise was limited, however, and only resulted in the addition of approximately 5 percent of households to the PPLS05 list. The agency then applied a proxy-means test (PMT) to all poor households to identify the extremely poor households targeted by PKH.18 From this pool of households, Statistics Indonesia used health and education survey data to demographically screen households on the roster and identify eligible household that met program criteria:19    Households with pregnant and/or lactating women. Households with children aged 0-15 years. Households with children aged 16-18 years who have not yet completed 9 years of basic education.

Statistics Indonesia delivered the list of eligible and poor households to the implementing agency – Ministry of Social Affairs (Kemensos) – which was responsible for finalizing and approving the PKH beneficiary list. To carry out this responsibility, the PKH Implementation Unit (UPPKH) conducted a series of assemblies to review the data with the potential PKH candidate households and approve the final PKH beneficiary list. Originally the program was designed to only include “very poor” households. Additional resources became available later to include a small percentage of households that were identified as “poor.”20 Not all eligible poor households, however, were included in the pilot program. A cut-off point was established and PKH benefits were then rationed to eligible poor households who were closer to the bottom end of the consumption distribution. In the end, a total of approximately 430,000 beneficiary households were identified through this selection process.

2.5

Transfer Delivery and Verification Mechanisms

Typical of conditional cash transfer program elsewhere, Program Keluarga Harapan delivers a quarterly cash transfer to mothers. Women are more likely to be primary caregivers and, as such, are more likely to take care of the daily nutritional and health needs of children, and ensure that children attend school. The program, therefore, provides an unmeasured empowering benefit for women by providing them with greater access to (and potentially control over) resources for investing in their families. The PKH cash benefit is transferred directly to mothers through the nearest post office. There are no specific
17

An extremely poor household is defined by Statistics Indonesia as one whose living conditions are inadequate, whereby a large portion of their income is used for basic staple food consumption and they are unable to afford medical treatment except at the community health clinic or other public health facilities subsided by the government. They are also unable to buy clothing once a year, cannot afford to send their children to school or can afford schooling for their children only until junior high school. 18 The PMT consisted of 29 variables that included housing characteristics, education attainment levels, fuel sources, type of employment and access to health and education services. 19 The eligibility verification process relied on data from the Health and Education Basic Service Survey (Survei Pelayanan Dasar Kesehatan dan Pendidikan), a Statistics Indonesia survey. 20 Ayala, 2010.

17

rules about how the transfer must be used be beneficiary households. The program designers hoped, however, that beneficiary families would use the transfer to contribute towards the health of women and children as well as basic education of their children. The amount of the cash transfer was designed to be approximately equal to 15-20 percent of the estimated consumption of poor households. Annual households disbursements vary between Rp 600,000 and Rp 2.2 million per year. The amount is based on the number of the children in the household and their ages (Table 2.2). For example, if a mother is pregnant and/or has children aged 0-6 years, she will receive Rp 1,000,000 per year or Rp 250,000 per quarter, regardless of the number of under-five children. If a mother has two primary-school aged children (6-12 years) and one secondaryschool aged child (13-15 years) and these children are attending school, she will receive Rp 1,800,000 per year or Rp 450,000 per quarter. A mother with a child 0-6 years and three primary school-aged children will receive Rp 2,200,000 per year, the maximum possible annual transfer amount.
Table 2.2 Calculation of Annual Cash Transfer Amounts (Rupiah, per household) Fixed cash transfer Cash transfer for per household with a. Child aged less than 6 years b. Pregnant or lactating mother c. Children of primary-school age d. Children of secondary-school age Minimum transfer per household Maximum transfer per household 800,000 800,000 400,000 800,000 600,000 2,200,000 200,000

Source: Government of Indonesia, Ministry of Social Affairs (Kemensos)

Each household continues to receive their allocation in quarterly tranches as long as they meet the health and education conditions, which were specified at the beginning of the program. These conditions include the following: Households with pregnant or lactating women i. Complete four antenatal care visits and take iron tablets during pregnancy. ii. Be assisted by a trained professional during the birth. iii. Lactating mothers must complete two post-natal care visits. iv. Ensure that the children have complete childhood immunization and take Vitamin A capsules a minimum of twice a year. v. Take children for growth monitoring check-ups (monthly for infants 0-11 months, and quarterly for children 1-6 years). vi. Enroll their children in primary school and ensure attendance for a minimum of 85 percent of school days. vii. Enroll junior secondary school children and ensure attendance for a minimum of 85 percent of school days. viii. Enroll their children in an education program to complete 9 18

Households with children aged 0-6 years

Households with children aged 615 years

Households with children aged 16-

18 years but have not completed nine years of primary and secondary school

years equivalent.

Trained PKH facilitators provide beneficiaries with information and advice and are responsible for explaining the importance of adhering to the stipulations and conditions of PKH so that the cash support they receive will not be discontinued. The verification process relies on health and education service providers, which are delivered back to the district PKH office (regional UPPKH). The officials are expected to input the compliance verification data online before initiation of following payments. If, at any time, the health and education conditions are not being met, beneficiary households will at first receive a warning letter that will be delivered by a PKH facilitator. The second breach will result in a ten (10) percent discount of the benefit. After the third breach, non-compliant households will be expelled from the program and not receive any further transfers.

2.6

Complementary Programs

PKH is one of the government’s eight major household-centered social assistance programs (Table 2.3). A temporary unconditional cash transfer program (BLT) was deployed in 2005 and again in 2008-09 to mitigate the inflationary impact caused by fuel price adjustments as well as to protect vulnerable households from the effects of the global financial crisis. Raskin aims to distribute subsidized rice to 18 million families across the country. Jamkesmas is a health insurance for the poor program that covers 18.2 million households, making it the largest permanent program in terms of coverage. There is a range of cash transfer programs that provide assistance to students from poor families for education costs. These programs join an array of small programs targeting highly vulnerable groups including at-risk children (PKSA), the disabled (JSPACA) and vulnerable elderly (JSLU). These programs form the basis of an emerging social safety net in Indonesia. Several national programs work alongside PKH to improve the provision of basic health and education services for poor families, including the Operational Health Assistance program (Bantuan Operational Kesehatan, BOK) and the national School Aid Program (Bantuan Operational Sekolah, BOS). In addition to these, the government decided to also launch a complementary community-based conditional cash transfer program, PNPM-Generasi. The program, piloted under the flagship National Community Empowerment Program (Program Nasional Penberdayaan Masyarakat, PNPM-Mandiri), provides annual block grants to communities that have committed to improve health and education outcomes. The grants can be used for a variety of purposes to improve the supply of local health and education services, such as hiring extra midwives for the village, improving health buildings and schools, providing school uniforms and education materials, or building a road to improve access to facilities. The amount of the grant for subsequent years is based on village performance against health and education development indicators.

Table 2.3. Indonesia has 8 major household-centered social assistance programs
(Summary of major GOI household-centered social assistance programs as of 2010)

19

Name

Transfer Type Cash

Target group Poor & near-poor households Poor & near-poor households Poor & near-poor households Students from poor households

Target number of beneficiaries 18.7 Mn HHs

Coverage

Benefit level IDR 100,000 per month for 9 months 14 kg rice per month Varies depending on utilization IDR 561,759 per year

Key executing agency

1. BLT*

National

Ministry of Social Affairs (Kemensos) Bureau of Logistics (BULOG) Ministry of Health (Kemenkes) Ministry of National Education (Kemdiknas) & Ministry of Religious Affairs (Kemenag) Kemensos Kemensos

2. Raskin 3. Jamkesmas

Subsidized Rice Health service fees waived Cash & Conditions

17.5 Mn HHs 18.2 Mn HHs

National National

4. BSM

4.6 Mn students

National, but not full scale

5. PKH 6. PKSA

Cash & Conditions Cash, Conditions, & Services Cash & Services Cash & Services

Very poor households Vulnerable children

810,000 HHs 4,187

Pilot Pilot

IDR 1,287,000 per year IDR 1,800,000 per year IDR 3,600,000 per year IDR 3,600,000 per year

7. JSPACA 8. JSLU

Vulnerable disabled Vulnerable elderly

17,000 10,000

Pilot Pilot

Kemensos Kemensos

Source: World Bank Staff. *During last usage in 2008-09.

A recent evaluation of the Generasi program found that improving services through conditional block grants improves some key development outcomes, especially in low-performing areas. The program successfully improved participation in village health post activities, the frequency of weight checks for young children, and the number of iron sachets that pregnant women received through antenatal care visits.21 The program also demonstrated a decrease in malnutrition rates for children aged 0-3 years old, and increased school participation rates for students aged 7-12 years old. PNPM-Generasi can be especially effective in regions where the provision of health and education services is very limited (i.e., the program was about twice as effective in areas at the 10th percentile of service provision).

21

Benjamin Olken, Junko Onishi and Susan Wong, “Indonesia’s PNPM Generasi Program: Final Impact Evaluation Report,” October 2010 (Forthcoming).

20

3

Program Implementation Assessment

Implementation assessments of the Program Keluarga Harapan pilot provide a snapshot of the quality of the main operational aspects of the program, which is useful in interpreting the results of the impact evaluation. Because PKH is one of the government’s largest “next generation” social assistance programs, it has been closely observed and monitored. The Center for Health Research at the University of Indonesia, for example, conducted a “spot check” exercise to observe implementation of the program in nine districts across six provinces, during October 2009 – February 2010. In addition, SMERU, an Indonesian research institute, conducted a qualitative assessment of the program’s performance from 2007 until 2010. Although the program has been continuously improving, there were a series of implementation problems during the initial three years of the program. These problems may have contributed to dampening the effect of the program on improving health and education behaviors and outcomes. 3.1 Program Socialization

As is common practice for most social assistance programs and other government-provided services in Indonesia, socialization and advertising activities were delegated to the Ministry of Communication and Information (Kemenkominfo). An operations engineering report, however, found that program socialization for PKH was deficient in content, frequency, and intensity.22 Program beneficiaries did not receive written materials and time allocated for information dissemination was limited. Spot checks revealed that only beneficiaries were informed about the program. In order to avoid the potential for jealousy and conflict, village officials and non-beneficiary households in the same locations were not informed about the program.23 Village officials and local service providers were therefore often unaware of the program. In five surveyed treatment areas, for example, all midwives complained that they were not involved in the program and one had not even heard of PKH. 24 Even PKH program officers were sometimes unable to answer simple questions about program goals or eligibility criteria. As a result, many stakeholders reportedly perceived PKH as if it were an unconditional cash transfer.25 Lack of socialization also led to false notions of eligibility for social assistance – for example, beneficiaries and PKH facilitators alike were unaware that PKH beneficiaries were eligible for all other government social assistance schemes for poor households. 3.2 Verification Systems

The program’s conditionality verification system did not start working as outlined in the program implementation manual until 2010. This was largely due to the lack of a functioning management information system (MIS). There were four main issues that contributed to this problem. First, the forms provided by UPPKH to record the new flows of information were not always available to personnel at the relevant offices. Service providers found the forms confusing and lacked the capacity to fill them out in a timely manner. Second, there were too few human resources at both service providers (including PT Pos, health providers and schools) and the local UPPKH offices to efficiently handle the flows of information that were being generated. As a result, backlogs in data entry and processing
22 23

Ayala, 2010. SMERU, 2011. 24 SMERU, 2011. 25 Center for Health Research, University of Indonesia, 2010.

21

occurred almost immediately. Third, in some regions the information recorded on forms did not enter an MIS system capable of aggregating information and transmitting it on to the PKH units responsible for managing demographic updates and compliance verification results.26 Finally, personnel at education and health service providers received too little training prior to the introduction of PKH and were unprepared to assist in the delivery the unique outreach, intake (at the service center), and data recording processes that the PKH program utilizes. During the first two years of implementation, verification of compliance and recalculation of benefits were not fully operational. As a result, there were few – if any – penalties for non-compliant households. Most households continued to receive their initial allocations; the actual average annual payments per household did not decrease over the three-year pilot evaluation period (Table 3.1). There are indications, however, that beneficiary households were aware of the threat of losing full payment in areas where facilitators made extra efforts to inform them about the consequences of non-compliance. In remote areas, however, facilitators reportedly spent more time traveling and completing their administrative responsibilities, than working directly with families and informing them about program expectations.27
Table 3.1 Actual PKH Payments 2007 Number of kecamatan Number of households per kecamatan Average total payment per kecamatan (Rp) Average payment per year per household 337 1,151 1,506,687,189 1,308,967 2008 671 605 1,145,539,115 1,265,341 2009 732 923 1,207,852,971 1,308,377

Source: Government of Indonesia, Ministry of Social Affairs (Kemensos)

3.3

Adequacy and Timing of Payments

The amount of the payments may not be adequate for beneficiary households to meet some of the program’s conditions. For example, the poorest 20 percent of households in Indonesia spend, on average, Rp 2.8 million for a year of secondary education per student, which represents approximately 30 percent of total household expenditures. The additional income that a family receives from PKH is not likely to be sufficient to enable them to afford to enroll children in secondary education, especially considering that the average PKH family has over five children. Similarly, midwives reportedly cost anywhere from Rp 150,000 in some rural areas to as much as Rp 800,000 in urban areas, which may be unaffordable for beneficiaries even after receiving the PKH benefit.28 This problem was further compounded by delivering the payment in tranches, which reduced the amount of additional funds for school or midwife fees. Households tend to use PKH funds immediately for daily consumption needs and do not tend to save for planned education and health costs.29 Therefore, it is important to time payments so that additional
26

Additional complications were power outages; a mismatch between BPS household data (that higher-level PKH implementing units were using) and PKH-collected demographic data on the same households (which lower-level PKH implementing units were collecting); and a lack of advance awareness of service providers and beneficiaries regarding the conditions households are responsible for meeting in order to receive the cash transfer portion of PKH. 27 SMERU, 2011. 28 SMERU, 2011. 29 SMERU, 2011.

22

funds are available when needed by beneficiary families. For example, if payments are timed to arrive just before the calendar school year begins, parents will have the funds needed to afford school registration fees. During the first two years of PKH operation, however, payments did not coincide with school placement fees. While these fees are typically due in May, payments were only made in July (during 2008 and 2009) or later (November in 2007). Moreover, actual disbursements were sometime later than scheduled disbursements. Approximately 11 percent of interviewed beneficiaries reported that payment was delayed two weeks from the scheduled disbursement date.30 3.4 Inter-Agency Coordination

The success of the CCT program depends on ensuring that public service providers are able to respond to increased usage. For this reason, close cross-agency collaboration and coordination is critical. A wide range of central agencies collaborated in designing and implementing the PKH program, including: the National Development Planning Agency (Bappenas), the Coordinating Ministry for Social Welfare (Kemenkokesra), the Ministry of Social Affairs (Kemensos), the Ministry of National Education (Kemdiknas), the Ministry of Health (Kemenkes), Statistics Indonesia (BPS), the Ministry of Communications and Information Technology (Kemenkominfo) and the national post office (PT Pos). A centralized program implementation team (UPPKH) was established to oversee program implementation and is housed in Kemensos. Local implementation of the program, meanwhile, falls under the responsibility of program units at the provincial and district/municipality levels. An important aspect of inter-agency coordination for conditional cash transfer programs is to ensure that health and education services are prepared for additional uptake of patients and school children. To address this issue, only districts with sufficient availability of services (i.e. "supply-ready") were eligible for participation. Despite this precaution, implementation assessment reports found that there were still significant problems in service availability in the kecamatan where PKH was piloted. 12.5 percent of all monitored puskesmas, for example, did not have complete vaccination stocks and interviewed beneficiaries also complained about storage of vitamins.31 This was especially a problem in NTT province where posyandu services were difficult to access from remote areas (some households would have to walk for hours to reach the closest one) and there were limited staff and midwives to provide all the required services.32 Similarly, while all households had easy access to primary schools, those in areas such as NTT still had difficulties in reaching junior secondary schools – a problem that was exacerbated by the unavailability of public transportation services. Inter-agency coordination difficulties also emerged in the targeting of household-centered social assistance programs. Although Jamkesmas is meant to provide health insurance coverage for the poor, not all PKH households were included as beneficiaries. PKH households were often under the impression that their PKH cards would be sufficient to access all health services. Without Jamkesmas cards, some interviewed beneficiaries reported that they still could not afford to access local public health services.33 Similarly, few PKH households were also the recipients of programs implemented by the Kemdiknas and the Ministry of Religion (Kemenag), which aim to provide assistance to poor students to enroll and stay in school.

30 31

Center for Health Research, University of Indonesia, 2010. Center for Health Research, University of Indonesia, 2010. 32 SMERU, 2011. 33 Center for Health Research, University of Indonesia, 2010.

23

A mostly complete physical supply of services is likely not enough to effectively change long-term behaviors and expectations among PKH households. All affiliated service providers have to be PKH “owners” in the sense that they are all invested in providing conditioned services, outreach, and followup to beneficiaries. For example, health service providers not should not only record a household’s progress with conditioned services but should also provide information about healthy practices at home; should provide access to other low-cost or no-cost health services either publicly or privately provided; and should provide encouragement and reminders to new PKH households to continue complying with conditions and visiting modern health care facilities for regular treatment. In PKH’s early stages, service providers were not generally PKH program owners in this way and were given no special training to learn how to function as PKH program owners.

3.5

Improvements in Implementation

Over 2009 and 2010, PKH administrators instituted reforms to address some of the implementation challenges and bottlenecks have eased. In particular, the MIS system is now fully functional and demographic updates are being processed. As of late 2010, over 85 percent of households were captured in the compliance verification system (a component of the MIS system). The content of the verification forms have been revised to make them easier for service providers to use while the printing and supply chain of those forms has been rationalized in consultation with PT Pos, who is responsible for delivering the forms, and the PKH facilitators, who are responsible for alerting households to actions they must take as well as scheduled delivery of PKH funds. In addition, payment schedules have been changed back to the original quarterly schedule and are synchronized with the academic year. The revision and delays in quarterly payments were due in part to the mismatch between records, lack of household verification, and lack of information throughput in the MIS system. The improvements mentioned above to the sub-processes in the overall MIS system as well as to the form printing and delivery supply chain have already alleviated the payment backlog problem and UPPKH has explicitly enforced the original quarterly payment schedule; this payment schedule is now synchronized with the school fee schedule.

24

4
4.1

Program Evaluation Design
Evaluation Indicators

The initial allocation of PKH funds to sub-districts and the evaluation survey instruments were designed so that program impacts could be measured accurately. A baseline survey, fielded prior to the first PKH transfer, was fielded between June and August 2007. It included a random sample of beneficiary and non-beneficiary (i.e., eligible-but-not-receiving) households in randomly selected PKH treatment subdistricts (kecamatan). The survey also included a random sample of eligible households in randomly selected control areas (i.e., sub-districts scheduled not to receive PKH). These same households participated in a follow-up survey fielded in October to December 2009, approximately 2 years after the initial PKH payments. The follow-up survey used the original baseline questionnaire and respondent lists.34 This impact evaluation report summarizes the estimated effects of PKH on the following immediate (short-term) outcomes: household consumption; the utilization of preventative health services; school enrollment, attendance, and hours; and child labor indicators. The analysis also measures impacts, focusing on changes in long-term health and education changes.35 For example, Table 4.1 provides examples of some of the immediate outcomes and impacts tracked in this evaluation.36
Table4.1 PKH Evaluation Indicators Immediate Outcomes Welfare        Total Household expenditure (per-capita) Food Household expenditure (per-capita) Education Household expenditure (per-capita) Health Household expenditure (per-capita) Share of food expenditure on protein Complete childhood immunization Participation in child growth and development monitoring program (weighing children under 5 regularly) Children taking Vitamin A tablets Prenatal healthcare visits Consumption of iron tablets during pregnancy Births assisted by trained professionals (doctor or midwife) Postnatal healthcare visits   Expected Long-term Impact Decrease in malnutrition indicators Consistent infant weight gain

Children health

  

 Maternal health    

 

Consistent infant weight gain Decrease in the incidence of diarrhea Decrease in malnutrition indicators (incidence of child stunting, wasting and underweight) Decrease in infant mortality Decrease in maternal mortality

34

A separate but qualitatively similar household and community facility survey (both baseline and follow-up) was fielded in PNPM-Generasi treatment and control areas during the same time period. 35 The distinction between short- and long-term outcomes or impacts is neither purely arbitrary nor purely empirical. The judgment call made here adopts an approach common in the program impact literature and involves a consensus-based determination of the likely time horizons over which affected behaviors can produce changes in human capital indicators. 36 The mapping from Immediate Outcomes is not meant to be one-to-one with the corresponding row in Impacts. Some indicators are logically both Immediate Outcomes and Impacts (e.g. child labor), and some logically appear in more than one area of activity (e.g. share of household food expenditure on protein).

25

Education

   

Primary school enrollment for children aged 7-12 Regular primary school attendance (= SD (90%) coeff 0.000 -0.087 0.012 0.003 0.090 -0.231 0.023 0.077 -0.052 -0.091 0.012 0.053 0.037 0.005 0.002 0.018 -0.007 0.001 0.004 0.000 -0.001 -0.023 0.014 0.408 0.003 0.002 -0.011 0.007 0.018 0.699 std err

0.119 0.070 0.022 0.015 0.151 0.132 0.014 0.037 0.178 0.207 0.011 0.045 0.017 0.017 0.013 0.017 0.004 0.002 0.002 0.002 0.005 0.001 0.008 0.008 0.187 0.005 0.001 0.006 0.021 0.012 0.299 0.007

** *

**

**

0.15 0.09 0.03 0.02 0.19 0.16 0.02 0.05 0.21 0.24 0.01 0.06 0.02 0.02 0.02 0.02 0.01 0.00 0.00 0.00 0.01

0.059 -0.034 -0.007 -0.003 0.195 -0.244 ** 0.025 *** -0.003 0.192 0.026 0.002 * -0.016 * 0.065 -0.029 -0.024 * 0.002 -0.015 0.005 0.006 0.007 0.002 0.002 -0.027 -0.004 -0.294 0.014 0.001 -0.020 -0.026 0.036 0.488 -0.014

0.21 0.11 0.04 0.02 0.26 0.22 0.03 0.06 0.32 0.37 0.02 0.08 0.03 ** 0.03 0.02 0.03 0.01 ** 0.00 0.00 0.00 * 0.01 0.00 0.01 * 0.01 0.33 0.01 * 0.00 0.01 * 0.04 0.02 0.52 0.02

0.38 0.22 0.07 0.04 0.45 0.44 0.05 ** 0.13 0.28 0.88 0.04 0.13 ** 0.06 0.06 0.04 0.06 0.01 0.01 0.01 0.01 0.00 0.03 0.03 * 0.65 0.02 0.00 0.02 0.06 ** 0.04 0.93

0.13 0.07 0.02 0.02 0.16 0.14 * 0.01 0.04 ** 0.19 0.21 0.01 0.05 0.02 ** 0.02 0.01 0.02 0.00 0.00 0.00 * 0.01 0.00 0.01 0.01 0.20 0.01 0.00 0.01 0.02 0.01 0.31

-0.002 *** -0.021 0.014 * 0.648 -0.006 0.002 * -0.005 0.011 -0.002 ** 0.706 -0.001

0.00 0.01 ** 0.01 0.23 *** 0.01 0.00 0.01 0.03 0.01 0.36 * 0.01

*** * **

*

**

91

B1 participation coeff Child Labor Wage work during the last month yes/no (7-12 yrs) Wage work during the last month yes/no (13-15 yrs) Wage work (7-12 yrs) last week Wage work (7-12 yrs) last month Wage work (13-15 yrs) last week Wage work (13-15 yrs) last month Family enterprise work (7-12 yrs) last week Family enterprise work (7-12 yrs) last month Family enterprise work (13-15 yrs) last week Family enterprise work (13-15 yrs) last month Household work (7-12 yrs) last week Household work (7-12 yrs) last month Household work (13-15 yrs) last week Household work (13-15 yrs) last month Consumption Total expenditure, per-capita Non-food expenditure, per-capita Education expenditure, per-capita Health expenditure, per-capita Food expenditure, per-capita Alcoholic beverages expenditure, per-capita Tobacco expenditure, per-capita Share of food expenditure on protein Per-capita grains Per-capita tubers Per-capita fish Per-capita meats Per-capita egg milk Per-capita vegetables Per-capita legumes Per-capita fruits Per-capita oil fat Per-capita beverages Per-capita spices Per-capita other Per-capita served food % pts % pts hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs IDR IDR IDR IDR IDR IDR IDR % pts -0.005 -0.001 -2.041 -0.034 0.814 -0.339 1.943 0.520 2.932 1.184 -0.011 0.259 -0.101 0.338 -4835 334 849 1556 -3647 -32 -1244 0.006 std err

Agriculture Agri (64%) coeff std err

Mother's Education Low: < SD (10%) coeff -0.012 0.017 *** * *** * -0.551 22.1 0.407 0.042 0.97 -1.43 0.532 1.052 1.081 4.384 0.57 0.027 0.18 *** -0.740 1.35 -0.402 0.96 2.27 2.45 0.54 1.49 0.82 3.17 0.588 3.40 1.49 -0.081 0.325 -0.197 0.117 -5,789 -1,375 616 719 -4,414 -21 -1,656 0.004 717 468 472 -1001 533 158 -160 -107 -134 -113 159 -388 -310 0.13 3.62 0.52 0.24 ** 1.10 *** 0.76 ** 0.18 0.49 0.33 1.21 5,588 2,277 647 819 4,715 114 602 0.00 707 230 442 436 293 314 256 250 175 262 146 249 705 std err

Non-Agri (36%) coeff std err

High: >= SD (90%) coeff -0.003 -0.003 std err

0.004 -0.009 0.010 -0.006 2.389 -4.98 0.126 -0.029 3.334 -1.36 0.489 -0.424 0.707 *** 1.20 0.238 ** 0.430 1.020 *** 3.55 0.729 2.01 0.166 -0.039 0.461 0.294 0.311 -0.609 1.133 -1.767 5278 2141 626 862 * 4433 105 559 ** 0.003 ** -366 -1,603 1,145 2,380 1,238 -62 -1,807 0.006 718 291 1011 -1107 723 -97 237 -73 -13 -449 173 -304 -853

0.00 0.01 3.44 0.17 2.29 0.46 0.72 0.30 1.14 0.97 0.20 0.59 0.37 1.39 5,852 2,663 733 980 4,728 150 659 0.00 884 310 508 513 320 374 300 308 207 320 169 289 772

**

0.006 0.007 -7.10 -0.066 -12.3 -0.259 * 7.77 0.680 *** 0.811 ** -0.181 -0.044 0.479 0.673 3.622

0.01 0.02 1.93 0.17 6.85 1.09 1.98 0.39 2.25 1.06 0.31 0.76 0.56 1.95

0.01 0.03

0.00 0.01

*

-14,376 10,897 -545 3,927 283 1,181 ** -121 1,704 -13,831 9,516 84 88 *** -496 1,153 * 0.001 0.01 299 1009 422 203 ** ** -244 744 ** -710 774 ** 148 604 488 499 -678 440 30 368 -298 295 413 398 53 250 -260 452 191 1371

6,977 15,425 -13 8,623 3,307 2,500 13,389 5,469 ** 6,990 10,811 -17 116 1,577 2,152 0.013 0.01 -754 2673 -957 790 2444 1282 * -1056 1908 414 1419 -477 1031 1308 969 987 880 86 664 -862 985 -39 518 1165 1084 -3832 2750

***

** ** *

92

B1 participation coeff Health Behaviors Iron tablets ≥ 90 tabs during pregnancy Pre-natal vists Pre-natal visits ≥ 4 visits Assisted Delivery Delivery at facility Post-natal visits Post-natal visits ≥ 2 visits Breastfeeding: yes or no Breastfeeding: hours after delivery of first breastfeeding Breastfeeding: total months breastfeeding Weighings ≥ 1 weighing past month (0-11 mths) Weighings ≥ 1 weighing past month (1-3 yrs) Weighings ≥ 1 weighingpast month (0-5 yrs) Immunization complete by schedule for age Immunization complete Vitamin A times received Vitamin A received ≥ 2 times during past year Vitamin A received on schedule Traditional health facility outpatient visits Traditional health facility outpatient visits (all HH members) Traditional health facility outpatient visits (all HH members) Public health facility outpatient visits Public health facility outpatient visits (all HH members) Public health facility outpatient visits (all HH members) Private health facility outpatient visits Private health facility outpatient visits (all HH members) Private health facility outpatient visits (all HH members) % pts # % pts % pts % pts # % pts % pts hours mths % pts % pts % pts % pts % pts # % pts % pts # # % pts # # % pts # # % pts 0.016 0.576 0.093 0.037 0.051 0.350 0.096 0.004 -1.753 0.351 0.065 0.152 0.226 0.043 0.033 0.056 0.021 0.015 0.002 0.003 0.001 0.009 0.030 0.005 0.001 0.018 0.002 std err

Father's Education Low: < SD (29%) coeff std err

Head of Household Male (92%) coeff 0.015 0.505 0.090 0.042 0.056 0.382 0.103 0.003 -2.54 0.721 0.092 0.155 0.231 0.056 0.038 0.099 0.030 0.030 0.002 0.003 0.001 0.008 0.026 0.006 0.002 0.019 0.002 std err

High: >= SD (71%) coeff 0.014 0.695 0.105 0.064 0.105 0.395 0.135 0.009 -3.41 0.403 ** 0.017 *** 0.166 *** 0.225 0.031 * 0.020 0.025 -0.002 -0.003 * 0.000 * 0.000 * 0.001 * 0.006 *** 0.025 *** 0.005 0.003 0.026 0.003 std err

Female (8%) coeff std err

0.026 0.242 0.028 0.031 0.032 0.185 0.035 0.006 1.681 0.418 0.045 0.028 0.021 0.026 0.019 0.073 0.026 0.023 0.002 0.004 0.000 0.005 0.009 0.001 0.003 0.008 0.001

0.024 0.411 0.078 0.070 -0.005 * 0.115 *** 0.003 -0.017 2.07 1.209 ** *** 0.210 0.157 0.238 0.079 * 0.073 0.148 0.074 0.053 0.008 0.012 * 0.001 * 0.021 *** 0.044 *** 0.008 -0.005 ** -0.008 -0.002 *** ***

0.05 0.44 0.05 0.06 0.06 0.35 0.06 0.01 3.21 0.83 0.10 0.05 0.04 0.05 0.04 0.14 0.05 0.05 0.00 0.01 0.00 0.01 0.01 0.00 0.01 0.02 0.00

0.03 0.29 0.03 0.04 0.04 0.22 0.04 0.01 2.01 0.53 0.05 0.03 0.02 0.03 0.02 0.09 0.03 0.03 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.01 0.00

** *** * *** * *** *

0.03 0.25 0.03 0.03 0.03 0.19 0.04 0.01 1.75 0.46 0.05 0.03 0.02 0.03 0.02 0.08 0.03 0.02 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.01 0.00

-0.008 ** 2.288 *** 0.210 0.253 * 0.230 ** -0.135 *** -0.166 0.029 12.7 -0.382 * *** *** ** * -0.127 0.182 0.216 -0.071 -0.023 -0.072 -0.056 -0.091 0.008 0.007 ** -0.001 0.005 *** 0.076 *** 0.005 -0.006 ** 0.004 0.000

0.12 0.87 0.10 0.11 0.13 0.72 0.14 0.02 7.42 1.71

*** ** ** *

*

*** ***

** *** *** **

0.21 0.12 0.09 ** 0.09 0.07 0.23 0.11 0.09 0.01 0.02 0.00 0.02 0.04 * 0.00 0.01 0.03 0.01

93

B1 participation coeff Health Outcomes Weight Weight-for-age Malnutrition (according to weight-for-age zscore) Severe Malnutrition (according to weight-for-age zscore) Height-for-age Weight-for-height Diarrhea Treated diarrhea Diarrhea number of episodes Diarrhea length of last episode ARI Treated ARI Fever Cough Cough and rapid breath Illness Mortality 0-28 days Mortality 1-2 months Mortality 3-5 months Mortality 6-11 months Mortality 0-11 months Education Gross Participation Rate (7-12 yrs) Net Enrollment in primary school (7-12 yrs) Attendance primary school ≥ 85% (7-12 yrs) Hours in school last week (7-12 yrs) Late enrollment rate primary school Drop-out rate primary school Gross participation rate age (13-15 yrs) Nett in enrollment secondary school (13-15 yrs) Attendance primary school ≥ 85% (13-15 yrs) Hours in school last week (13-15 years) Transition rates kg Zscore % pts % pts Zscore Zscore % pts % pts # days % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts hrs % pts % pts % pts % pts % pts hrs % pts -0.073 -0.065 0.004 0.002 0.071 -0.187 0.030 0.071 -0.053 0.013 0.010 0.038 0.042 0.010 0.004 0.023 -0.002 0.002 0.002 0.005 0.005 -0.001 -0.023 0.009 0.319 0.001 0.002 -0.011 0.000 0.014 0.638 -0.004 std err

Father's Education Low: < SD (29%) coeff 0.297 0.067 -0.074 -0.021 0.318 -0.121 0.037 0.119 0.019 0.097 -0.017 0.054 0.020 -0.040 -0.034 -0.010 -0.006 0.000 0.006 0.005 0.005 std err

Head of Household Male (92%) coeff -0.009 -0.094 0.012 0.005 0.104 -0.260 0.029 0.075 -0.053 0.011 0.011 0.058 0.045 0.007 0.003 0.023 -0.007 0.001 0.004 0.000 -0.001 -0.025 0.010 0.369 0.003 0.002 -0.010 0.005 0.016 0.699 -0.002 std err

High: >= SD (71%) coeff -0.108 -0.104 0.031 0.009 0.006 -0.212 0.030 0.066 -0.204 0.034 0.024 0.075 0.056 0.032 0.021 0.040 -0.006 0.002 -0.001 0.004 -0.001 0.000 -0.023 0.009 0.313 -0.007 -0.001 0.000 0.007 0.001 0.529 -0.002 std err

Female (8%) coeff std err

0.119 0.070 0.022 0.015 0.151 0.132 0.014 0.037 0.178 0.207 0.011 0.045 0.017 0.017 0.013 0.017 0.004 0.002 0.002 0.002 0.005 0.001 0.008 0.008 0.187 0.005 0.001 0.006 0.021 0.012 0.299 0.007

** *

**

**

0.23 0.14 0.04 * 0.03 0.28 0.23 0.03 0.07 * 0.48 0.42 0.02 0.09 0.03 0.03 0.02 0.03 0.01 0.00 0.01 0.00 0.01 0.00 0.01 0.02 0.36 0.01 0.00 0.01 0.04 0.02 0.56 0.02

0.15 0.08 0.03 0.02 0.18 0.16 0.02 0.04 0.16 0.24 0.01 0.05 0.02 0.02 0.01 0.02 0.00 0.00 0.00 0.00 0.01

*

* ***

**

0.13 0.07 0.02 0.02 0.16 0.14 0.01 0.04 0.19 0.22 0.01 0.05 0.02 0.02 0.01 0.02 0.00

0.309 0.363 -0.136 -0.054 -0.049 * 0.705 ** 0.089 ** -0.001 0.440 -0.146 -0.013 0.330 *** 0.000 0.063 0.020 0.055 0.002 0.002 0.011 0.014

0.44 0.24 0.09 0.05 0.55 0.47 0.05 * 0.15 0.34 0.44 0.04 0.25 0.06 0.07 0.05 0.06 0.01 0.01 0.01 0.02 0.01 0.03 0.03 0.76 0.02 0.01 0.01 * 0.06 0.03 0.80 0.03

0.00 0.00 * 0.01 0.00 0.01 0.01 0.19 0.00 0.00 0.01 0.02 0.01 0.32 0.01

-0.002 *** -0.022 0.012 * 0.492 0.024 0.008 * -0.036 -0.023 0.042 ** 1.087 0.004

*

** ** ** * *

0.00 0.01 ** 0.01 0.22 0.01 0.00 0.01 0.02 0.01 0.35 0.00

0.005 *** -0.003 -0.020 * -0.107 -0.011 0.000 * -0.026 -0.055 -0.003 ** 0.393 -0.032

94

B1 participation coeff Child Labor Wage work during the last month yes/no (7-12 yrs) Wage work during the last month yes/no (13-15 yrs) Wage work (7-12 yrs) last week Wage work (7-12 yrs) last month Wage work (13-15 yrs) last week Wage work (13-15 yrs) last month Family enterprise work (7-12 yrs) last week Family enterprise work (7-12 yrs) last month Family enterprise work (13-15 yrs) last week Family enterprise work (13-15 yrs) last month Household work (7-12 yrs) last week Household work (7-12 yrs) last month Household work (13-15 yrs) last week Household work (13-15 yrs) last month Consumption Total expenditure, per-capita Non-food expenditure, per-capita Education expenditure, per-capita Health expenditure, per-capita Food expenditure, per-capita Alcoholic beverages expenditure, per-capita Tobacco expenditure, per-capita Share of food expenditure on protein Per-capita grains Per-capita tubers Per-capita fish Per-capita meats Per-capita egg milk Per-capita vegetables Per-capita legumes Per-capita fruits Per-capita oil fat Per-capita beverages Per-capita spices Per-capita other Per-capita served food % pts % pts hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs IDR IDR IDR IDR IDR IDR IDR % pts -0.005 -0.001 -2.041 -0.034 0.814 -0.339 1.943 0.520 2.932 1.184 -0.011 0.259 -0.101 0.338 -4835 334 849 1556 -3647 -32 -1244 0.006 std err

Father's Education Low: < SD (29%) coeff std err

Head of Household Male (92%) coeff -0.004 -0.001 * 0.028 -0.327 -0.455 *** * 0.706 1.44 -0.032 0.400 -0.234 -0.009 -6,331 -1,475 635 722 -4,857 -16 -1,644 0.003 763 386 515 -1052 507 113 -189 -118 -147 -92 167 -379 -297 0.13 3.61 0.52 -0.853 -1.27 0.098 0.66 0.17 *** 1.30 0.98 ** 2.87 0.56 1.51 0.76 2.76 * std err

High: >= SD (71%) coeff std err

Female (8%) coeff -0.015 -0.011 std err

0.004 -0.015 0.010 0.010 2.389 11.1 0.126 -0.165 3.334 11.4 0.489 0.134 0.707 *** 0.54 0.238 ** 0.555 1.020 *** 6.16 0.729 1.83 0.166 -0.754 0.461 -1.30 0.311 -0.579 1.133 -0.98 5278 2141 626 862 * 4433 105 559 ** 0.003 ** -11,607 -5,858 -568 -14 -5,750 -49 -1,555 0.002 -804 334 -895 -1018 301 622 -257 -801 -312 168 -272 -674 -693

0.01 0.02 13.57 0.32 2.13 0.87 1.47 0.54 1.78 1.33 0.33 0.86 0.62 2.20

**

-0.001 -0.004 -4.61 -0.009 *** 0.850 -0.566 2.12 0.486 *** 1.21 0.93 ** 0.212 0.979 0.022 0.914 -2,335 318 1,424 2,152 -2,653 -16 -1,381 0.006 1152 287 1196 -1003 636 -125 19 267 -48 -325 304 -102 -536

0.00 0.01 2.38 0.12 4.27 0.59 0.79 0.26 1.23 0.88 0.19 0.55 0.36 1.34 6,548 2,573 773 1,063 5,577 113 692 0.00 827 275 485 501 361 356 289 283 199 301 168 283 802

0.00 0.01

0.01 0.04

0.25 *** -1.96 0.75 * 0.18 0.49 0.33 1.22 5,613 2,285 651 825 4,741 115 605 0.00 711 226 443 438 294 315 257 250 176 263 146 248 709 -2.27 0.324 0.451 0.885 4.814

*

8,629 4,259 1,027 1,417 6,733 242 1,068 0.01 1198 355 833 828 470 561 481 454 * 325 467 253 480 1304

* **

** *

** ** *

*

11,375 15,021 112 8,260 2,815 2,300 12,674 5,006 ** 11,263 10,454 -45 121 *** 1,338 2,045 0.015 0.01 -1259 2499 * -52 917 1794 1273 ** -627 1784 * 620 1329 27 1033 1353 907 1094 848 161 629 -1107 941 -114 490 788 1074 -3857 2547

95

B1 participation coeff Health Behaviors Iron tablets ≥ 90 tabs during pregnancy Pre-natal vists Pre-natal visits ≥ 4 visits Assisted Delivery Delivery at facility Post-natal visits Post-natal visits ≥ 2 visits Breastfeeding: yes or no Breastfeeding: hours after delivery of first breastfeeding Breastfeeding: total months breastfeeding Weighings ≥ 1 weighing past month (0-11 mths) Weighings ≥ 1 weighing past month (1-3 yrs) Weighings ≥ 1 weighingpast month (0-5 yrs) Immunization complete by schedule for age Immunization complete Vitamin A times received Vitamin A received ≥ 2 times during past year Vitamin A received on schedule Traditional health facility outpatient visits Traditional health facility outpatient visits (all HH members) Traditional health facility outpatient visits (all HH members) Public health facility outpatient visits Public health facility outpatient visits (all HH members) Public health facility outpatient visits (all HH members) Private health facility outpatient visits Private health facility outpatient visits (all HH members) Private health facility outpatient visits (all HH members) % pts # % pts % pts % pts # % pts % pts hours mths % pts % pts % pts % pts % pts # % pts % pts # # % pts # # % pts # # % pts 0.016 0.576 0.093 0.037 0.051 0.350 0.096 0.004 -1.753 0.351 0.065 0.152 0.226 0.043 0.033 0.056 0.021 0.015 0.002 0.003 0.001 0.009 0.030 0.005 0.001 0.018 0.002 std err

Per-capita Expenditure < median (53%) coeff std err

Sex male (50%) coeff std err

> median (47%) coeff std err

female (50%) coeff std err

0.026 0.242 0.028 0.031 0.032 0.185 0.035 0.006 1.681 0.418 0.045 0.028 0.021 0.026 0.019 0.073 0.026 0.023 0.002 0.004 0.000 0.005 0.009 0.001 0.003 0.008 0.001

0.046 ** 0.710 *** 0.106 0.051 0.014 * 0.125 *** 0.036 0.010 -4.41 1.41 0.053 *** 0.176 *** 0.218 0.038 * 0.045 0.098 0.016 0.015 0.004 0.003 * 0.001 * 0.016 *** 0.032 *** 0.006 0.000 ** 0.015 0.002

0.04 0.34 0.04 0.05 0.05 0.27 0.05 0.01 2.51 0.62 0.07 0.04 0.03 0.04 0.03 0.11 0.04 0.03 0.00 0.01 0.00 0.01 0.01 0.00 0.00 0.01 0.00

-0.009 ** 0.455 *** 0.077 0.049 0.099 0.624 0.157 -0.004 * 0.78 ** -0.187 0.067 *** 0.133 *** 0.238 0.052 * 0.023 0.025 0.019 0.007 * -0.001 0.003 0.001 ** -0.001 *** 0.029 *** 0.005 0.001 0.020 0.001

0.04 0.35 0.04 0.04 0.04 0.26 0.05 0.01 2.29 0.64 0.06 0.04 0.03 0.04 0.03 0.10 0.04 0.03 0.00 0.01 0.00 0.01 0.01 0.00 0.00 0.01 0.00

** ** ** *** 0.003 -0.26 1.23 *** *** 0.015 0.153 0.207 0.121 0.085 0.116 -0.013 0.025 0.004 0.01 2.58 0.63 * 0.06 0.04 0.03 0.04 0.03 0.11 0.04 0.03 0.00 *** *** *** *** 0.006 -3.24 0.045 0.063 0.152 0.251 -0.050 -0.027 0.033 0.051 0.006 0.000 0.01 2.18 0.62 0.06 0.04 *** 0.03 *** 0.04 0.03 0.10 0.04 0.03 0.00

0.012 ** ** -0.002 *

0.01

0.006

0.01

0.00

0.004

0.00

96

B1 participation coeff Health Outcomes Weight Weight-for-age Malnutrition (according to weight-for-age zscore) Severe Malnutrition (according to weight-for-age zscore) Height-for-age Weight-for-height Diarrhea Treated diarrhea Diarrhea number of episodes Diarrhea length of last episode ARI Treated ARI Fever Cough Cough and rapid breath Illness Mortality 0-28 days Mortality 1-2 months Mortality 3-5 months Mortality 6-11 months Mortality 0-11 months Education Gross Participation Rate (7-12 yrs) Net Enrollment in primary school (7-12 yrs) Attendance primary school ≥ 85% (7-12 yrs) Hours in school last week (7-12 yrs) Late enrollment rate primary school Drop-out rate primary school Gross participation rate age (13-15 yrs) Nett in enrollment secondary school (13-15 yrs) Attendance primary school ≥ 85% (13-15 yrs) Hours in school last week (13-15 years) Transition rates kg Zscore % pts % pts Zscore Zscore % pts % pts # days % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts % pts hrs % pts % pts % pts % pts % pts hrs % pts -0.073 -0.065 0.004 0.002 0.071 -0.187 0.030 0.071 -0.053 0.013 0.010 0.038 0.042 0.010 0.004 0.023 -0.002 0.002 0.002 0.005 0.005 -0.001 -0.023 0.009 0.319 0.001 0.002 -0.011 0.000 0.014 0.638 -0.004 std err

Per-capita Expenditure < median (53%) coeff 0.187 0.047 -0.001 -0.007 0.066 -0.077 0.030 0.137 -0.484 -0.067 0.009 0.068 0.037 0.030 0.006 0.045 -0.010 0.003 0.005 0.006 0.004 std err

Sex male (50%) coeff 0.041 -0.081 0.037 -0.004 0.183 -0.236 0.022 0.078 -0.027 0.009 0.010 0.010 0.041 0.002 0.006 0.014 std err

> median (47%) coeff std err

female (50%) coeff -0.007 -0.062 -0.022 0.012 -0.080 -0.104 0.042 0.081 -0.070 -0.030 0.011 0.101 0.040 0.017 0.003 0.030 std err

0.119 0.070 0.022 0.015 0.151 0.132 0.014 0.037 0.178 0.207 0.011 0.045 0.017 0.017 0.013 0.017 0.004 0.002 0.002 0.002 0.005 0.001 0.008 0.008 0.187 0.005 0.001 0.006 0.021 0.012 0.299 0.007

** *

**

**

0.18 0.10 0.03 0.02 0.20 0.19 0.02 0.05 0.21 0.31 0.01 0.06 0.02 0.02 0.02 0.02 0.01 0.00 0.00 0.00 0.01 0.00 0.01 0.01 0.25 0.01 0.00 0.01 0.03 0.02 0.40 0.01

-0.113 -0.165 0.007 0.010 0.092 -0.269 0.037 *** 0.004 ** 0.418 -0.026 0.009 0.047 * 0.049 -0.012 0.001 ** 0.002 * 0.000 -0.001 * -0.001 ** 0.003 -0.002 0.000 -0.034 0.010 0.305 0.005 0.004 -0.025 -0.025 0.012 0.880 -0.014

0.17 0.10 * 0.03 0.02 0.22 0.19 0.02 * 0.05 0.30 0.27 0.02 0.06 0.03 * 0.03 0.02 0.02 0.01 0.00 0.00 0.00 0.01 0.00 0.01 0.01 0.28 0.01 0.00 0.01 0.03 0.02 0.45 0.01

0.17 0.10 0.03 0.02 0.21 0.19 0.02 0.05 0.27 0.31 0.02 0.06 0.02 * 0.02 0.02 0.02

0.17 0.10 0.03 0.02 0.22 0.18 0.02 ** 0.05 0.23 0.27 0.02 0.06 0.02 * 0.02 0.02 0.02

-0.001 *** -0.015 0.008 * 0.367 -0.002 0.000 * -0.002 0.018 0.017 ** 0.398 0.004

***

* ***

*

0.000 -0.013 0.004 0.356 -0.002 0.000 -0.004 0.027 0.009 0.907 -0.001

0.00 0.000 0.01 -0.036 0.01 0.014 0.26 0.326 0.01 0.006 0.00 0.004 0.01 -0.020 0.03 -0.020 0.02 0.013 0.42 ** 0.345 0.01 -0.010

0.00 0.01 *** 0.01 0.27 0.01 0.00 * 0.01 ** 0.03 0.02 0.43 0.01

97

B1 participation coeff Child Labor Wage work during the last month yes/no (7-12 yrs) Wage work during the last month yes/no (13-15 yrs) Wage work (7-12 yrs) last week Wage work (7-12 yrs) last month Wage work (13-15 yrs) last week Wage work (13-15 yrs) last month Family enterprise work (7-12 yrs) last week Family enterprise work (7-12 yrs) last month Family enterprise work (13-15 yrs) last week Family enterprise work (13-15 yrs) last month Household work (7-12 yrs) last week Household work (7-12 yrs) last month Household work (13-15 yrs) last week Household work (13-15 yrs) last month Consumption Total expenditure, per-capita Non-food expenditure, per-capita Education expenditure, per-capita Health expenditure, per-capita Food expenditure, per-capita Alcoholic beverages expenditure, per-capita Tobacco expenditure, per-capita Share of food expenditure on protein Per-capita grains Per-capita tubers Per-capita fish Per-capita meats Per-capita egg milk Per-capita vegetables Per-capita legumes Per-capita fruits Per-capita oil fat Per-capita beverages Per-capita spices Per-capita other Per-capita served food % pts % pts hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs hrs IDR IDR IDR IDR IDR IDR IDR % pts -0.005 -0.001 -2.041 -0.034 0.814 -0.339 1.943 0.520 2.932 1.184 -0.011 0.259 -0.101 0.338 -4835 334 849 1556 -3647 -32 -1244 0.006 std err

Per-capita Expenditure < median (53%) coeff std err

Sex male (50%) coeff -0.001 -0.004 -6.27 0.041 1.99 -0.228 0.01 -0.080 3.03 1.73 0.213 0.774 0.477 2.60 std err

> median (47%) coeff std err

female (50%) coeff std err

0.004 0.002 0.010 -0.012 2.389 -2.24 0.126 0.153 3.334 0.471 0.489 -0.340 0.707 *** 2.62 0.238 ** 0.540 1.020 *** 2.64 0.729 0.21 0.166 0.068 0.461 0.788 0.311 -0.034 1.133 1.18 5278 2141 626 862 * 4433 105 559 ** 0.003 ** -140 -2,906 943 2,717 2,766 -140 -2,131 0.003 466 -85 451 -990 668 -102 257 142 -317 -354 -60 -525 -197

0.00 -0.012 0.01 0.011 2.15 -6.09 0.15 -0.290 4.30 -13.9 0.66 -0.503 1.02 *** 1.72 0.34 0.442 1.44 * 3.50 1.08 2.58 0.22 -0.110 0.60 -0.139 0.44 -0.151 1.58 -0.154 6,760 2,552 846 1,298 5,893 130 661 0.00 929 294 467 488 303 356 329 287 219 309 161 290 817 -10,969 -750 812 371 -10,219 99 -843 0.004 688 772 510 -1100 224 218 -376 -252 81 -51 322 -65 -979

0.01 0.01 4.44 0.22 6.52 0.73 0.97 0.33 1.42 0.97 0.26 0.73 0.45 1.65

**

** * ** ***

0.01 0.02 3.64 0.22 4.29 0.62 0.86 0.30 1.17 0.93 0.24 0.53 0.39 1.22

-0.009 0.002 * 2.08 -0.138 -1.19 -0.534 4.77 1.190 *** 2.14 * 0.39 -0.142 0.189 -0.331 ** -1.103

0.00 * 0.01 4.88 0.10 7.42 0.78 1.15 *** 0.38 *** 1.75 1.14 0.23 0.76 0.46 1.90

**

***

** **

*

8,157 3,544 929 1,126 6,673 169 952 0.00 1003 332 ** 700 711 502 486 373 388 259 400 231 396 1105

98