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Cochrane systematic review on ‘Unconditional cash transfers for reducing poverty: effect on health services use and health outcomes in low- and middle-income countries’

Cochrane Public Health group published a systematic review in November 2017 where evidence on the effect of unconditional cash transfers (UCTs) on health service use and health outcomes among children and adults in low and middle income countries (LMICs) was established

Public Health Evidence South Asia (PHESA) is currently contextualizing the findings of the current systematic review to South Asia. The contextualization of systematic review findings to South Asia is being done by a team of experts in the field of economics and healthcare at PHESA.

The evidence current to May 2017 included experimental and selected non-experimental studies of UCTs in people of all ages in LMICs. The studies were included based on comparison of participants who received a UCT with those who did not receive UCT. Included studies examined health services use and health outcomes. Twenty one studies (16 experimental and 5 non-experimental ones) with 1,092,877 participants (36,068 children and 1,056,809 adults) and 31,865 households in Africa, the Americas and South-East Asia were included in the systematic review. The studies were Government programmes or research experiments funded by national governments or international organizations.

The word 'probably' was used to indicate moderate-quality evidence, 'may/maybe' for low-quality evidence, and 'uncertain' for very low-quality evidence. The findings of the systematic review suggest that UCT may not impact the likelihood of having used any health service in the previous 1 to 12 months. UCTs probably led to a clinically meaningful, very large reduction in the risk of having had any illness in the previous two weeks to three months. They may increase the likelihood of having had secure access to food over the previous month. They may also increase the average number of different food groups consumed in the household over the previous week. The effect of UCTs on the likelihood of stunting and on depression levels remain uncertain despite several studies providing evidence. UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school. The evidence was uncertain for whether UCTs impacted livestock ownership, extreme poverty, participation in child labour, adult employment and parenting quality. UCTs may increase the amount of money spent on health care. The effects of UCTs on differences in health were very uncertain. Harms from UCTs were not identified.

Of the seven prioritised primary outcomes, the body of evidence for one outcome was of moderate quality, for three outcomes of low quality, for two outcomes of very low quality, and for one outcome, there was no evidence at all. This body of evidence suggested unconditional cash transfer (UCTs) may not impact health services use among children and adults in LMICs. UCTs probably or may improve some health outcomes, one social determinant of health and healthcare expenditure. The evidence on the health effects of UCTs compared with those of conditional cash transfers was uncertain. The systematic review can be accessed at http://www.cochrane.org/CD011135/PUBHLTH_unconditional-cash-transfers-reducing-poverty-effect-health-services-use-and-health-outcomes-low-and

The contextualization of the current systematic review will be available on the PHESA blog in February 2018.
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