Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts

Siddiqi, Arjumand; Rajaram, Akshay; Miller, Steven P.

doi:10.1136/archdischild-2017-314301

Cited by 40 publications

(33 citation statements)

References 37 publications

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“…Cash transfers alone have had limited impact on distal outcomes for child well-being (e.g., on nutritional status and health [ 4 , 5 ]), despite strong evidence that cash transfers can improve more proximal outcomes, such as improving access to food [ 3 , 13 , 14 ]. Thus, cash-plus programmes were developed in hopes of achieving improvements in these distal, “third-order” outcomes.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries

et al. 2021

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Background To strengthen the impact of cash transfers, these interventions have begun to be packaged as cash-plus programmes, combining cash with additional transfers, interventions, or services. The intervention’s complementary (“plus”) components aim to improve cash transfer effectiveness by targeting mediating outcomes or the availability of supplies or services. This study examined whether cash-plus interventions for infants and children <5 are more effective than cash alone in improving health and well-being. Methods and findings Forty-two databases, donor agencies, grey literature sources, and trial registries were systematically searched, yielding 5,097 unique articles (as of 06 April 2021). Randomised and quasi-experimental studies were eligible for inclusion if the intervention package aimed to improve outcomes for children <5 in low- and middle-income countries (LMICs) and combined a cash transfer with an intervention targeted to Sustainable Development Goal (SDG) 2 (No Hunger), SDG3 (Good Health and Well-being), SDG4 (Education), or SDG16 (Violence Prevention), had at least one group receiving cash-only, examined outcomes related to child-focused SDGs, and was published in English. Risk of bias was appraised using Cochrane Risk of Bias and ROBINS-I Tools. Random effects meta-analyses were conducted for a cash-plus intervention category when there were at least 3 trials with the same outcome. The review was preregistered with PROSPERO (CRD42018108017). Seventeen studies were included in the review and 11 meta-analysed. Most interventions operated during the first 1,000 days of the child’s life and were conducted in communities facing high rates of poverty and often, food insecurity. Evidence was found for 10 LMICs, where most researchers used randomised, longitudinal study designs (n = 14). Five intervention categories were identified, combining cash with nutrition behaviour change communication (BCC, n = 7), food transfers (n = 3), primary healthcare (n = 2), psychosocial stimulation (n = 7), and child protection (n = 4) interventions. Comparing cash-plus to cash alone, meta-analysis results suggest Cash + Food Transfers are more effective in improving height-for-age (d = 0.08 SD (0.03, 0.14), p = 0.02) with significantly reduced odds of stunting (OR = 0.82 (0.74, 0.92), p = 0.01), but had no added impact in improving weight-for-height (d = −0.13 (−0.42, 0.16), p = 0.24) or weight-for-age z-scores (d = −0.06 (−0.28, 0.15), p = 0.43). There was no added impact above cash alone from Cash + Nutrition BCC on anthropometrics; Cash + Psychosocial Stimulation on cognitive development; or Cash + Child Protection on parental use of violent discipline or exclusive positive parenting. Narrative synthesis evidence suggests that compared to cash alone, Cash + Primary Healthcare may have greater impacts in reducing mortality and Cash + Food Transfers in preventing acute malnutrition in crisis contexts. The main limitations of this review are the few numbers of studies that compared cash-plus interventions against cash alone and the potentially high heterogeneity between study findings. Conclusions In this study, we observed that few cash-plus combinations were more effective than cash transfers alone. Cash combined with food transfers and primary healthcare show the greatest signs of added effectiveness. More research is needed on when and how cash-plus combinations are more effective than cash alone, and work in this field must ensure that these interventions improve outcomes among the most vulnerable children.

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Section: Methodsmentioning

confidence: 99%

“…A well-established evidence base indicates that cash transfers improve many aspects of children’s lives, including increased food security and improved school attendance [ 3 ]. Nevertheless, impacts have been more mixed and less overwhelming in more challenging areas of child development, including nutrition [ 4 ] and health [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries

et al. 2021

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“…The child support grant (CSG) is one of the SA government's key social protection instruments, and is the largest cash transfer programme on the African continent, currently reaching ~12 million children and targeting children aged 0 -18 years in poor households. Based on global syntheses that demonstrate the utility of cash transfers, [84][85] primary research led by SA scientists and scientists from elsewhere shows that the CSG is an important policy instrument for tackling childhood poverty and improving child health and wellbeing. It can have positive impacts on child health and development outcomes, including child growth, hunger and school attendance and performance in the local context.…”

Section: Case Study 3: Social Policy Health and The Child Support Grantmentioning

confidence: 99%

Moving towards universal health coverage: Strengthening the evidence ecosystem for the South African health system

et al. 2019

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“…Food and nutrition security is defined as a regular and permanent access to quality food, in sufficient quantity, without compromising access to other essential needs (Brasil, 2006). Among the governmental measures adopted in several countries (Siddiqi, Rajaram, & Miller, 2018), regarding the assurance of food security are the Cash Transfer Programs (CTP).…”

Section: Introductionmentioning

confidence: 99%

Perfil epidemiológico das famílias segundo a inserção no programa de transferência de renda residentes em cidades litorâneas do Nordeste do Brasil

Santos¹,

Vasconcelos²,

Barbosa³

et al. 2021

RSD

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Objetivo: Investigar o perfil epidemiológico de famílias residentes em municípios litorâneos do Nordeste brasileiro, considerando que estão cadastradas no Programa Brasileiro de Transferência de Renda (CTP). Métodos: Estudo transversal envolvendo amostra probabilística de 1.444 famílias representativas da região. Foi utilizado um questionário semiestruturado previamente testado, contendo questões sobre variáveis socioeconômicas, demográficas, antropométricas e de saúde, e também sobre a situação de segurança alimentar e nutricional durante as visitas domiciliares. As características da família foram simultaneamente beneficiadas e não beneficiadas pelo PSF que foi comparado. Os resultados foram expressos em proporções (%), com a respectiva razão de prevalência de intervalo de confiança de 95% como medida de associação, por meio de análise de regressão de Poisson com ajuste robusto de variância. Resultados: Havia 729 (50,5%) famílias cadastradas no PSF. As variáveis que melhor discriminaram as famílias beneficiadas pelo programa foram: escolaridade da dona de casa <4 anos (P = 0,010; RP: 1,16; IC 95%: 1,03-1,30); pertencer à classe econômica D ou E (P <0,001; RP: 1,30; IC 95%: 1,12-1,51); renda materna (P <0,001; RP: 0,50; IC 95%: 0,42-0,61); família em situação de insegurança alimentar (P <0,001; RP: 1,29; IC 95%: 1,13-1,47); maior número de moradores por domicílio (P <0,001; RP: 1,48; IC 95%: 1,34-1,64). Conclusões: As famílias beneficiadas pelo CTP apresentavam os piores indicadores socioeconômicos e demográficos e encontravam-se com maior frequência em situação de insegurança alimentar (72,0%).

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Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts

Cited by 40 publications

References 37 publications

Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries

Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries

Moving towards universal health coverage: Strengthening the evidence ecosystem for the South African health system

Perfil epidemiológico das famílias segundo a inserção no programa de transferência de renda residentes em cidades litorâneas do Nordeste do Brasil

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