Cash transfers and the social determinants of health: a conceptual framework

Abstract

Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs’ evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation.

Resources, relationships, and systems thinking should inform the way community health promotion is funded

“…Some lessons for funding communities may be analogous to those derived from the study of cash transfers to individuals to address the social determinants of health where there is growing literature on how context-levels factors inhibit, enable, or optimise the effect of money per se (Akresh et al, 2016;Handa et al, 2014;Owusu-Addo et al, 2019). In other words, funders of community health need to orchestrate, scrutinise, and constantly revise how they bring about change with a wider and more context-sensitive appreciation of what can be achieved, when and how.…”

The Latin American and Nigerian Conditional Cash Transfer Experience: A Comparative Analysis

“…Finally, programme designers are convinced that conditional cash transfer schemes are more acceptable to policy makers and taxpayers than unconditional cash transfer schemes. Other proponents of conditionality argue based on increased school enrolments (Whetten, Fontenla and Villa, 2019;Garcia, Harker and Ricaurte, 2016;Schady and Araujo, 2008), and improved access to health services and nutrition for poor households and communities (Owusu-Addo, Ranzaho and Smith, 2019;Lagarde et al, 2009;Attanasio et al, 2005). Further, some argue that conditionality in CCTs can be helpful, as long as countries move towards the progressive realisation of universal rights, and also provide access without excluding anyone in need (Orton 2014;Sepulveda 2011).…”

Políticas sociais na saúde bucal – Revisão

“…Determinantes sociais de saúde são políticas sociais que estão direta e indiretamente relacionados com promoção de saúde para indivíduos e comunidades 13 . A promoção de saúde fomenta a qualidade de vida através de pré-requisitos de recursos fundamentais: paz, habitação, educação, alimentação, renda, ecossistema estável, recursos sustentáveis, justiça social e equidade 14 .…”

“…Numa visão de coletividade, a saúde é determinada biologicamentepor fatores endógenos/biológicos, e socialmente por fatores exógenos/contexto de vida que resulta na produção social 15 . A intersetorialidade desses fatores se constituí nas políticas sociais de bem estar que atuam diferentemente nas sociedades, cada qual com suas necessidades ou escolhas com participação das comunidades 13 . Essas políticas sociais associadas com a distribuição de renda, combatem iniquidades na saúde para populações de baixa renda.…”

“…A redistribuição de renda promovem redução e até erradicação da pobreza em países de média e baixa renda que impacta direta e indiretamente sobre a saúde dos povos 7,21,22 . Então é um fator coadjuvante de direitos humanos pois reduz inequidades sociais, minimiza desigualdades entre indivíduos e comunidades e promove o desenvolvimento dos países 13,17 .…”