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. 2015 Sep 11;2015(9):CD011247.
doi: 10.1002/14651858.CD011247.pub2.

Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low- and middle-income countries

Frank Pega  1 , Sze Yan Liu, Stefan Walter, Stefan K Lhachimi
Affiliations

Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low- and middle-income countries

Frank Pega et al. Cochrane Database Syst Rev. .

Abstract

Background: Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs).

Objectives: To assess the effects of UCTs in improving health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. We also compared the relative effectiveness of UCTs delivered in-hand with in-kind transfers, conditional cash transfers, and UCTs paid through other mechanisms.

Search methods: We searched 17 academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews (The Cochrane Library 2014, Issue 7), MEDLINE, and EMBASE between May and July 2014 for any records published up until 4 May 2014. We also searched grey literature databases, organisational websites, reference lists of included records, and academic journals, as well as seeking expert advice.

Selection criteria: We included randomised and quasi-randomised controlled trials (RCTs), as well as cohort, interrupted time series, and controlled before-and-after studies (CBAs) on UCTs in LMICs. Primary outcomes were the use of health services and health outcomes.

Data collection and analysis: Two authors independently screened all potentially relevant records for inclusion criteria, extracted the data, and assessed the included studies' risk of bias. We requested missing information from the study authors.

Main results: Three studies (one cluster-RCT and two CBAs) comprising a total of 13,885 participants (9640 children and 4245 adults) as well as 1200 households in two LMICs (Nicaragua and Niger) met the inclusion criteria. They examined five UCTs between USD 145 and USD 250 (or more, depending on household characteristics) that were provided by governmental, non-governmental or research organisations during experiments or pilot programmes in response to droughts. Two studies examined the effectiveness of UCTs, and one study examined the relative effectiveness of in-hand UCTs compared with in-kind transfers and UCTs paid via mobile phone. Due to the methodologic limitations of the retrieved records, which carried a high risk of bias and very serious indirectness, we considered the body of evidence to be of very low overall quality and thus very uncertain across all outcomes.Depending on the specific health services use and health outcomes examined, the included studies either reported no evidence that UCTs had impacted the outcome, or they reported that UCTs improved the outcome. No single outcome was reported by more than one study. There was a very small increase in the proportion of children who received vitamin or iron supplements (mean difference (MD) 0.10 standard deviations (SDs), 95% confidence interval (CI) 0.06 to 0.14) and on the child's home environment, as well as clinically meaningful, very large reductions in the chance of child death (hazard ratio (HR) 0.26, 95% CI 0.10 to 0.66) and the incidence of severe acute malnutrition (HR 0.44, 95% CI 0.24 to 0.80). There was also a moderate reduction in the number of days children spent sick in bed (MD - 0.36 SDs, 95% CI - 0.62 to - 0.10). There was no evidence for any effect on the proportion of children receiving deworming drugs, height for age among children, adults' level of depression, or the quality of parenting behaviour. No adverse effects were identified. The included comparisons did not examine several important outcomes, including food security and equity impacts.With regard to the relative effectiveness of UCTs compared with a food transfer providing a relatively high total caloric value, there was no evidence that a UCT had any effect on the chance of child death (HR 2.27, 95% CI 0.69 to 7.44) or severe acute malnutrition (HR 1.15, 95% CI 0.67 to 1.99). A UCT paid in-hand led to a clinically meaningful, moderate increase in the household dietary diversity score, compared with the same UCT paid via mobile phone (difference-in-differences estimator 0.43 scores, 95% CI 0.06 to 0.80), but there was no evidence for an effect on social determinants of health, health service expenditure, or local markets and infrastructure.

Authors' conclusions: Additional high-quality evidence (especially RCTs of humanitarian disaster contexts other than droughts) is required to reach clear conclusions regarding the effectiveness and relative effectiveness of UCTs for improving health services use and health outcomes in humanitarian disasters in LMICs.

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Conflict of interest statement

Frank Pega ‐ None known

Sze Yan Liu ‐ None known

Stefan Walter ‐ None known

Stefan K Lhachimi ‐ None known

Figures

1
1
Conceptual framework of the causal relationship between an unconditional cash transfer and the use of health services and health outcomes (Pega 2014a)
2
2
Flowchart of study selection. Footnotes:
 aCochrane Public Health Group Specialised Register, n = 37; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, issue 7), n = 105; Ovid MEDLINE 1946 to May 2014 with Daily Update, n = 4950; EMBASE, n = 5210; Academic Search Premier, n = 2002; Business Source Complete, n = 1592; CINAHL, n = 527; EconLit ,n = 1329; 3IE database, n = 5; PsycINFO, n = 962; PubMed, n = 4626; Scopus, n = 692; Social Science Citation Index, n = 2569; Sociological Abstracts, n = 1852; The Campbell Library: The Campbell Collaboration (The Campbell Library, 2014, issue 10), n = 318; TRoPHI, n = 20; and WHOLIS, n =6.
 bProQuest Dissertations & Theses Database, n = 48; Open‐Grey, n = 317; OpenDOAR, n = 100; EconPapers, n = 100; Social Science Research Newtork eLibrary, n = 90; and National Bureau of Economic Research, n = 100.
 cGoogleScholar, n = 30; Scirus, n = 30; and ReliefWeb, n = 30.
 dAfrican Development Bank, n = 643; Asian Development Bank, n = 173; European Bank for Reconstruction and Development, n = 88; Inter‐American Development Bank, n = 184; World Bank, n = 437; United Kingdom Department for International Development, n = 411; Cash Transfer Projects in Humanitarian Aid, n = 29; and Save the Children, n = 34.
 eTwo hundred ninety‐four records published in the three academic journals with an included record, 151 records referenced in included records identified through handsearching, and 552 records of the eight relevant previous reviews of cash transfers.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 1 Unconditional cash transfer compared with no unconditional cash transfer (or co‐intervention only), outcome: 1.2 Died, previous three months.
5
5
Forest plot of comparison: 1 Unconditional cash transfer compared with no unconditional cash transfer (or co‐intervention only), outcome: 1.5 Became severely acutely malnourished, previous three months.
1.2
1.2. Analysis
Comparison 1 Unconditional cash transfer compared with no unconditional cash transfer (or co‐intervention only), Outcome 2 Died, previous three months.
1.5
1.5. Analysis
Comparison 1 Unconditional cash transfer compared with no unconditional cash transfer (or co‐intervention only), Outcome 5 Became severely acutely malnourished, previous three months.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011247

References

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References to ongoing studies

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