EQUITY 111: TWO ON CONDITIONAL CASH TRANSFERS

Monday, 1st of November 2010

EQUITY 111: TWO ON CONDITIONAL CASH TRANSFERS

Those who want a level playing field in child health will look closely at conditional cash transfer programmes, which, if properly designed and managed, tend to extend the benefits of health and nutrition interventions to those classes of society not previously reached.

1) CASH TRANSFERS AND CHILD SURVIVAL IN MOZAMBIQUE, MALAWI AND ETHIOPIA

This draft report from Save the Children Fund looks at the impact of cash transfers in three African countries. Among the conclusions:

‘The Social Cash Transfer programme in Malawi has benefited from a rigorous impact evaluation, including assessment of the impact of the programme on households and children. This has shown positive effects on many of the causes of child mortality, particularly health and nutrition. Children in households benefiting from the programme have been found to have experienced a greater reduction in incidence of illness and improved dietary diversity and durability. The programme is still operational in only six districts, with plans for the programme to be scaled up to all 28 districts in 2012. This will enable the programme to have a more profound impact on child health and nutrition, nationally. The challenge in developing an integrated, national social protection ystem is to ensure that the Social Support Policy is finalised and implemented as soon as possible, including effective scale�]up of the social transfer programme.’

Full text is at http://erd.eui.eu/media/2010/Hypher_Lasting%20Benefits_Mozambique%20Malawi%20and%20Ethiopia.pdf

2) CCTs FOR IMPROVING UPTAKE OF HEALTH INTERVENTIONS

This most recent published review on the health impact of conditional cash transfers dates from 2007. In a rapidly developing area, an update would be more than useful.

Full text is at http://jama.ama-assn.org/cgi/content/full/298/16/1900

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Vol. 298 No. 16, October 24/31, 2007

Review

Conditional Cash Transfers for Improving Uptake of Health Interventions in Low- and Middle-Income Countries

A Systematic Review

Mylene Lagarde, MSc; Andy Haines, MD; Natasha Palmer, PhD

JAMA. 2007;298:1900-1910.

Context Cash transfers conditional on certain behaviors,intended to provide access to social services, have been introducedin several developing countries. The effectiveness of thesestrategies in different contexts has not previously been thesubject of a systematic review.

Objective To assess the effectiveness of conditional monetarytransfers in improving access to and use of health services,as well as improving health outcomes, in low- and middle-incomecountries.

Data Sources Relevant publications were identified viaelectronic medical and social science databases from inceptionto April 2006 (PubMED, EMBASE, POPLINE, CAB Direct, HealthcareManagement Information Consortium, WHOLIS (World Health OrganizationLibrary Database), African Healthline, International Bibliographyof the Social Sciences (IBSS), Eldis, British Library for DevelopmentStudies (BLDS), ID21, Journal Storage (Jstor), Inter-Science,ScienceDirect, Internet Documents in Economics Access Service(Research Papers in Economics) (IDEAS[Repec]), Latin Americanand Caribbean Health Sciences Literature (LILACS), MEDCARIB,Virtual Library in Health (ADOLEC), Pan American Health Organization(PAHO), FRANCIS, The Cochrane Central Register of ControlledTrials, the Database of Abstracts of Reviews of Effectiveness,and the Effective Practice and Organization of Care Group (EPOC)Register. Reference lists of relevant papers and "gray" literatureresources were also searched.

Study Selection To be included, a paper had to meet studydesign criteria (randomized controlled trial, interrupted timeseries analysis, and controlled before and after study) andinclude a measure of at least 1 of the following outcomes: healthcare utilization, health expenditure, or health outcomes. Twenty-eightpapers were retrieved for assessment and 10 were included inthis review.

Data Extraction Methodological details and outcomes wereextracted by 2 reviewers who independently assessed the qualityof the papers.

Results Overall, the evidence suggests that conditionalcash transfer programs are effective in increasing the use ofpreventive services and sometimes improving health status.

Conclusions Further research is needed to clarify thecost effectiveness of conditional cash transfer programs andbetter understand which components play a critical role. Thepotential success and desirability of such programs in low-incomesettings, with more limited health system capacity, also deservesmore investigation.

Author Affiliations: London School of Hygiene & Tropical Medicine, London, England.

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