Cash transfer conditionality
The conditionality intervention, henceforth the conditional cash transfer (CCT) intervention, was a one-time requirement for all children aged 0 to 59 months to attend the local clinic at the beginning of the study, where health staff screened their health and issued them with a CINS health record card. The child was offered any necessary vaccinations, but agreement to receive vaccination was not necessary to meet the conditionality. Children born after registration for the cash transfer had taken place were not required to attend.Households in the CCT intervention arm were actively encouraged to meet the conditionality, which all did. If households had failed to meet the conditionality, they would have been denied registration for the cash transfer programme. During registration for the cash transfer programme, we verified whether households in the CCT arm met the conditionality by asking the mothers/caregiver to show the child CINS health card. Additional checks of the child’s CINS health card were carried out monthly by study staff and community health workers (CHWs) to encourage any newly arrived children, in the households of the CCT arm, to be health screened and receive their CINS health card. The health record card was designed for the study based on recommendations from the World Health Organisation (WHO), the existing MoH Child Health booklet, and experience in Malawi, where passport-sized, home-based health record cards had been developed [All households in the CCT and unconditional cash transfer (UCT) arms had similar access to the local health clinic. In addition, CHWs visited all households in all the study arms each month to review the vaccination status of their children, aged 0 to 59 months, and to remind their caregivers of any due child vaccinations.