Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established.

Nicaragua's Red de Protección Social (RPS) was one of the first conditional cash transfer (CCT) programs implemented in a low-income country. In the program, cash is transferred to poor households on the condition that their children attend school and visit preventive healthcare providers. Supply-side incentives are also given to healthcare providers, who are paid on the basis of their performance against predetermined targets.

For poor families in the developing world, the cost of providing their children with adequate nutrition, effective health care and even minimal education can be very high. Beyond the price of food, health services, medicines, school fees, supplies and clothing, the trip to the health center may cost more in time or money than parents can afford. The youngster’s labor or earnings may be too crucial to the family’s economic survival to permit time for class.  

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