Title

Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low‐ and middle‐income countries

Document Type

Article

Publication Date

3-29-2022

Journal / Book Title

Cochrane Reviews

Abstract

To assess the effects of UCTs on health services use and health outcomes in children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure, and to compare the effects of UCTs versus CCTs.

Search methods

For this update, we searched 15 electronic academic databases, including CENTRAL, MEDLINE and EconLit, in September 2021. We also searched four electronic grey literature databases, websites of key organisations and reference lists of previous systematic reviews, key journals and included study records.

Selection criteria

We included both parallel‐group and cluster‐randomised controlled trials (C‐RCTs), quasi‐RCTs, cohort studies, controlled before‐and‐after studies (CBAs), and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (≥ 18 years) in LMICs. Comparison groups received either no UCT, a smaller UCT or a CCT. Our primary outcomes were any health services use or health outcome.

Data collection and analysis

Two review authors independently screened potentially relevant records for inclusion, extracted data and assessed the risk of bias. We obtained missing data from study authors if feasible. For C‐RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta‐analyses applied the inverse variance or Mantel‐Haenszel method using a random‐effects model. Where meta‐analysis was impossible, we synthesised results using vote counting based on effect direction. We assessed the certainty of the evidence using GRADE.

Main results

We included 34 studies (25 studies of 20 C‐RCTs, six CBAs, and three cohort studies) involving 1,140,385 participants (45,538 children, 1,094,847 adults) and 50,095 households in Africa, the Americas and South‐East Asia in our meta‐analyses and narrative syntheses. These analysed 29 independent data sets. The 24 UCTs identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 81.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT; three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection or performance bias, or both). Most studies were funded by national governments or international organisations, or both.

Throughout the review, we use the words 'probably' to indicate moderate‐certainty evidence, 'may/maybe' for low‐certainty evidence, and 'uncertain' for very low‐certainty evidence.

Published Citation

Pega, F., Pabayo, R., Benny, C., Lee, E.Y., Lhachimi, S.K. and Liu, S.Y., 2022. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low‐and middle‐income countries. Cochrane Database of Systematic Reviews, (3).

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