The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries

Lagarde M, Haines A, Palmer N

Published Online:

October 7, 2009

We found 29 papers on the impact of conditional cash transfers (CCT) on access to care and health outcomes. Of these, ten papers, reporting results from six studies, satisfied the inclusion criteria; four of these studies were randomised experiments. Despite a number of methodological weaknesses in some studies, overall the research evidence suggests that CCT schemes may result in a number of benefits to health for poor populations. Many conditional cash transfer programmes include a number of components, including incentivising attendance for health education, measurements of height and weight, immunisations and nutritional supplementation. Conditional cash transfer programmes appear to be an effective way to increase the uptake of preventive services and encourage some preventive behaviours. In some cases programmes have noted improvement of health outcomes, though it is unclear to which components this positive effect should be attributed.

Abstract (click to read)

Background:

Conditional cash transfers (CCT) provide monetary transfers to households on the condition that they comply with some pre-defined requirements. CCT programmes have been justified on the grounds that demand-side subsidies are necessary to address inequities in access to health and social services for poor people. In the past decade they have become increasingly popular, particularly in middle income countries in Latin America.

Objectives:

To assess the effectiveness of CCT in improving access to care and health outcomes, in particular for poorer populations in low and middle income countries.

Search strategy:

We searched a wide range of international databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, in addition to development studies and economic databases. We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature. The original searches were conducted between November 2005 and April 2006. An updated search in MEDLINE was carried out in May 2009.

Selection criteria:

CCT were defined as monetary transfers made to households on the condition that they comply with some pre-determined requirements in relation to health care. Studies had to include an objective measure of at least one of the following outcomes: health care utilisation, health expenditure, health outcomes or equity outcomes. Eligible study designs were: randomised controlled trial, interrupted time series analysis, or controlled before-after study of the impact of health financing policies following criteria used by the Cochrane Effective Practice and Organisation of Care Group.

Data collection and analysis:

We performed qualitative analysis of the evidence.

Main results:

We included ten papers reporting results from six intervention studies. Overall, design quality and analysis limited the risks of bias. Several CCT programmes provided strong evidence of a positive impact on the use of health services, nutritional status and health outcomes, respectively assessed by anthropometric measurements and self-reported episodes of illness. It is hard to attribute these positive effects to the cash incentives specifically because other components may also contribute. Several studies provide evidence of positive impacts on the uptake of preventive services by children and pregnant women. We found no evidence about effects on health care expenditure.

Authors' conclusions:

Conditional cash transfer programmes have been the subject of some well-designed evaluations, which strongly suggest that they could be an effective approach to improving access to preventive services. Their replicability under different conditions - particularly in more deprived settings - is still unclear because they depend on effective primary health care and mechanisms to disburse payments. Further rigorous evaluative research is needed, particularly where CCTs are being introduced in low income countries, for example in Sub-Saharan Africa or South Asia.

This record should be cited as:

Lagarde M, Haines A, Palmer N. The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD008137. DOI: 10.1002/14651858.CD008137

Assessed as up to date:

May 5, 2009

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Primary Review Group:

Effective Practice and Organisation of Care Group

Health topics:

Effective practice/health systems > Reviews of specific types of interventions > Financial interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries

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