Fighting poverty: UCTs show positive effects on health and school attendance rates

Two principles can generally be distinguished to fight poverty: unconditional or conditional programmes. Among those approaches, unconditional cash transfers (UCTs) are cash payments provided to financially disadvantaged people that do not require them to do anything in return. Governments in low and middle-income countries increasingly use these cash transfers to reduce poverty or other vulnerabilities. In 2011, somewhere between 800 million and 1 billion people in these countries received some form of cash transfer. Policy makers have noted that these income-boosting interventions might be used to improve the health of disadvantaged populations, if they were found to be effective for this purpose. Former Secretary-General of the United Nations Ban Ki-moon put emphasis on this topic during the World Humanitarian Summit in Istanbul in 2016. Within so-called „cash transfer programmes“ cash is either indirectly (e.g. vouchers) or directly provided to recipients.

Unconditional cash transfers can be used quite flexible by recipients, this ranges from buying food, clothes, or construction material to paying school fees or transport costs.

An international research team with researchers from New Zealand, the US, and Germany compared outcomes among people who received cash transfers versus those who did not receive them. They found twenty-one studies that had included a total of more than one million participants living in Africa, the Americas, and Southeast Asia. The studies covered 17 different cash transfer programs, and almost all were large cluster randomized trials. Unfortunately, though, most of the studies had a high risk of bias.

Eleven studies were combined in a quantitative meta-analyses. This body of evidence suggests that unconditional cash transfers probably do not impact on a summary measure of health service use. However, they might improve some health outcomes. For example, an unconditional cash transfer probably reduces the odds of having had any illness in the last two to twelve weeks by an estimated 27%. Professor Dr Stefan K. Lhachimi, head of the Research Group for Evidence-Based Public Health at the University of Bremen and BIPS and one of the review authors, was quoted by The Guardian recently: “This is a large and clinically meaningful reduction”.

There is some evidence, although low quality, that suggests unconditional cash transfers might also improve food security and dietary diversity. The review team also found that they probably improved one social determinant of health, namely increased school attendance; and increased the amount of money recipients spent to purchase healthcare. In conclusion, while unconditional cash transfers probably did not impact the use of health services, they probably improved some health outcomes, school attendance, and health care expenditures.

Further information

See the full Review on the Cochrane Library: Link
News item from the official Cochrane website including a Podcast: Link
A German translation of the “Plain Language Summary” via Cochrane Kompakt: Link

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