Podcast: Unconditional cash transfers for reducing poverty: effect on health services use and health outcomes in low- and middle-income countries

Most Cochrane Reviews examine the effects of healthcare interventions, but some look at other aspects of healthcare systems, such as how to help people access health services. In a new review in November 2017, a team of university researchers from Canada, Germany, India, New Zealand and the United States examine the possible role for unconditional cash transfers. One of the team, Sze Yan Liu from Weill Medical College at Cornell University in the US, tells us what they found in this podcast.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Most Cochrane Reviews examine the effects of healthcare interventions, but some look at other aspects of healthcare systems, such as how to help people access health services. In a new review in November 2017, a team of university researchers from Canada, Germany, India, New Zealand and the United States examine the possible role for unconditional cash transfers. One of the team, Sze Yan Liu from Weill Medical College at Cornell University in the US, tells us what they found in this podcast.

Sam: Unconditional cash transfers are cash payments provided to financially disadvantaged people that do not require them to do anything in return. Governments in low and middle-income countries increasingly use these cash transfers to reduce poverty or other vulnerabilities. In 2011, somewhere between 800 million and 1 billion people in these countries received some form of cash transfer.
Policy makers have noted that these income-boosting interventions might be used to improve the health of disadvantaged populations, if they were found to be effective for this purpose. So, we did our Cochrane review to see if they are effective and found some promising results.
We aimed to assess – for the first time - the effects that unconditional cash transfers have on health services use, health outcomes, social determinants of health and healthcare expenditure among children and adults in low- and middle-income countries.
We compared outcomes among people who received cash transfers versus those who did not receive them. We found twenty-one studies that had included a total of more than one million participants living in Africa, the Americas, and Southeast Asia. The studies covered 17 different cash transfer programs, and almost all were large cluster randomized trials. Unfortunately, though, most of the studies had a high risk of bias.
We combined eleven studies in a quantitative meta-analyses. This body of evidence suggests that unconditional cash transfers probably do not impact on a summary measure of health service use. However, they might improve some health outcomes. For example, an unconditional cash transfer probably reduces the odds of having had any illness in the last two to twelve weeks by an estimated 27%. This is a large and clinically meaningful reduction.
There is some evidence, although low quality, that suggests unconditional cash transfers might also improve food security and dietary diversity. We also found that they probably improved one social determinant of health, namely increased school attendance; and increased the amount of money recipients spent to purchase healthcare.
In conclusion, while unconditional cash transfers probably did not impact the use of health services, they probably improved some health outcomes, school attendance, and health care expenditures.

John: If you would like to look in more detail at the effects of these unconditional cash transfer programmes, and the content of the programmes themselves, you can find the full review online in the Cochrane Library. Just go to Cochrane Library dot com and search 'unconditional cash transfer'.

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