Sub-Saharan Africa: Cash transfers have a positive impact on social determinants of health
A systematic review has been published that looks at the effects of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa.
Researchers considered both quantitative (both experimental and quasi-experimental) and qualitative studies to be included in the review. To be eligible for inclusion quantitative studies needed: to be conducted in a population of people in sub-Saharan Africa; to investigate the effect of conditional or unconditional cash transfers when compared with other cash transfers, or no cash transfers; report at least one of the prespecified socio-economic outcomes. Qualitative studies that looked at barriers and facilitators to a successful cash transfer intervention were included. Further details of the review methods can be found in the review protocol.
Fifty-three studies were included: 3 randomised controlled trials (RCTs), 22 cluster-RCTs, 8 quasi-experimental studies and 20 qualitative studies. The studies were conducted in 14 countries across sub-Saharan Africa. Due to the diversity of populations and outcomes reported, the researchers did not conduct meta-analysis, instead opting for a narrative synthesis following the approach recommended by Popay et al. (2006). For the qualitative studies, thematic synthesis was carried out to combine the data, following the Thomas and Harden (2008) approach.
The review found that cash transfers can be effective in tackling structural determinants of health such as poverty, education, household resilience, child labour, social capital, civic participation, and birth registration. The review further reported an impact on intermediate determinants including material circumstances (e.g. nutrition, savings), psychosocial circumstances (e.g. self-esteem, reduced stress and anxiety), sexual risk behaviours among adolescents and adolescent empowerment. For this analysis the researchers lumped together unconditional and conditional cash transfer interventions when compared to a control group who did not receive any cash transfers.
Little evidence was reported in the review that compared unconditional and conditional cash transfers. Three studies found that conditional cash transfers were more effective than unconditional cash transfers in increasing school attendance (Baird et al 2011, Robertson et al 2012, Akresh et al 2013, 2016). On the other hand, one study in Malawi found significantly reduced psychological distress among adolescent schoolgirls who received unconditional cash transfers compared to conditional cash transfers (Baird et al. 2013).
More information at:
“The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review”, Health Policy and Planning, 2018