Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications

Abstract

Objective: To quantify the impact of cash transfer and microfinance interventions on a selected list of tuberculosis (TB) risk factors and assess their potential role in supporting TB control.

Data source: Published and unpublished references identified from clinical and social electronic databases, grey literature and web sites.

Methods: Eligible interventions had to be conducted in middle- or low-income countries and document an impact evaluation on any of the following outcomes: 1) TB or other respiratory infections; 2) household socio-economic position; and 3) factors mediating the association between low household socio-economic position and TB, including inadequate health-seeking behaviours, food insecurity and biological TB risk factors such as human immunodeficiency virus (HIV) and adult malnutrition. Interventions targeting special populations were excluded.

Results: Fifteen cash transfer schemes (four unconditional and 11 conditional) and seven microfinance programmes met the eligibility criteria. No intervention addressed TB or any other respiratory infection. Of 11 cash transfer and four microfinance interventions, respectively seven and four reported a positive impact on indicators of economic well-being. A positive impact on household food security was documented in respectively eight of nine and three of five cash transfer and microfinance interventions. Improved health care access was documented respectively in 10 of 12 cash transfer and four of five microfinance interventions. The only intervention evaluating impact on HIV incidence was a microfinance project that found no effect. No cash transfer or microfinance interventions had an impact on adult malnutrition.

Conclusions: Cash transfer and microfinance interventions can positively impact TB risk factors. Evaluation studies are urgently needed to assess the impact of these social protection interventions on actual TB indicators.

Figure

Conceptual framework. In this review we focus on tuberculosis (TB) disease and interventions targeting socio-economic position at household level. It is hypothesised that cash transfer, either conditional or unconditional, and microfinance interventions can support TB control by improving a household’s socio-economic position and thereby reducing the exposure to biological risk factors (such as human immunodeficiency virus and malnutrition) and improving the household food security and health-seeking behaviour.