Conditional Cash Research Articles

Improving diabetes control for Syrian refugees in Jordan: a longitudinal cohort study comparing the effects of cash transfers and health education interventions

BackgroundCash transfers are an increasingly common intervention in the Syrian refugee response to meet basic needs, though there is little known of their potential secondary impact on health outcomes in humanitarian settings.MethodsA quasi-experimental prospective cohort study was implemented from October 2018 through January 2020 to assess the effectiveness of multi-purpose cash (MPC), community health volunteer (CHV)-led education, combined with conditional cash transfers (CCT) with respect to health measures among Syrian refugees with type II diabetes in Jordan.ResultsCHV + CCT participants had the highest expenditures at endline and were the only group with statistically significant increases in payments for outpatient diabetes care (25.3%, P < 0.001) and monthly medication costs (13.6%, P < 0.001). Conversely, monthly spending on diabetes medication decreased significantly in the CHV only group (− 18.7%, P = 0.001) yet increased in the MPC and CHV + CCT groups. Expenditures on glucose monitoring increased in all groups but significantly more in the CHV + CCT group (39.2%, P < 0.001).The proportion of participants reporting regular diabetes care visits increased significantly only in the CHV + CCT group (15.1%, P = 0.002). Specialist visits also increased among CHV + CCT participants (16.8%, P = 0.001), but decreased in CHV only participants (− 27.8%, P < 0.001). Decreases in cost-motivated provider selection (− 22.8%, P < 0.001) and not receiving all needed care because of cost (− 26.2%, P < 0.001) were significant only in the CHV + CCT group.A small significant decrease in BMI was observed in the CHV + CCT group (− 1.0, P = 0.005). Decreases in HbA1C were significant in all groups with magnitudes ranging from − 0.2 to − 0.7%. The proportion of CHV + CCT participants with normal blood pressure increased significantly from baseline to endline by 11.3% (P = 0.007).ConclusionsCombined conditional cash and health education were effective in improving expenditures, health service utilization, medication adherence, blood pressure, and diabetes control. The lower cost health education intervention was similarly effective in improving diabetes control, whereas unconditional cash transfers alone were least effective. Study findings suggest that conditional cash or combined cash and health education are promising strategies to support diabetes control among refugees and that where the purpose of MPC is to improve health outcomes, this alone is insufficient to achieve improvements in the health of refugees with diabetes.

Conditional vs unconditional cash transfers: a study of poverty demographics in Pakistan

This paper aims to provide a detailed demographic description of poverty in Pakistan with an attempt to highlight those segments of the poor who can be aided to transition out of extreme poverty through appropriate policy measures. Data are collected from the Household Integrated Economic Survey (HIES) for the years 1985–2016 and captures falling poverty, gender-wise division of the employed and unemployed, type of employment (self-employed, unpaid workers, employers, employees) by gender, labour participation of vulnerable age groups, as well as unemployed widows. The paper discusses the effectiveness of conditional (CCT) and unconditional (UCT) cash transfer programs across the world and using data indicators, highlights the appropriate target groups in need of such intervention in Pakistan. The existing components of BISP are discussed, with policy recommendations targeted to enhance its impact by focusing UCTs on the most vulnerable segments. CCTs can be used to improve health and education outcomes; given Pakistan’s lagging performance, illiteracy among youth, infant and maternal health are of particular consideration. Cash transfers can be made conditional, subject to regular health checkups for mothers and children and mandatory school attendance to improve these outcomes. The paper further suggests an extension of the program to provide short-term financial relief to the temporarily unemployed.

Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania.

We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV in Tanzania. At three clinics, 805 participants were randomized to three groups in a 3 : 3 : 1 ratio, stratified by site : nutrition assessment and counseling (NAC) and cash transfers (∼$11/month, n = 347), NAC and food baskets (n = 345), and NAC-only (comparison group, n = 113, clinicaltrials.gov NCT01957917). Eligible people living with HIV were at least 18 years, initiated ART 90 days or less prior, and food insecure. Cash or food was provided for 6 or less consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR ≥ 95%) at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months. The primary intent-to-treat analysis included 800 participants. Achievement of MPR ≥ 95% at 6 months was higher in the NAC + cash group compared with NAC-only (85.0 vs. 63.4%), a 21.6 percentage point difference [95% confidence interval (CI): 9.8, 33.4, P < 0.01]. MPR ≥ 95% was also significantly higher in the NAC + food group vs. NAC-only (difference = 15.8, 95% CI: 3.8, 27.9, P < 0.01). When directly compared, MPR ≥ 95% was similar in the NAC + cash and NAC + food groups (difference = 5.7, 95% CI: -1.2, 12.7, P = 0.15). Compared with NAC-only, appointment attendance and LTFU were significantly higher in both the NAC + cash and NAC + food groups at 6 months. At 12 months, the effect of NAC + cash, but not NAC + food, on MPR ≥ 95% and retention was sustained. Short-term conditional cash and food assistance improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania.

The promise and limitations of cash transfer programs for HIV prevention

As the search for more effective HIV prevention strategies continues, increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date, studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility, costs and benefits at scale, among other things, remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness – in number of HIV infections averted – against other prevention interventions. If a cash transfer program were to be taken to scale, the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls’ educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention.

Conditional versus unconditional cash: a commentary

To condition or not to condition; that is a question that preoccupies social protection experts and policy-makers alike, and one that divides rights-based camps from the incentives-based ones. This commentary argues that this debate may be a red herring. The line between conditional and unconditional (or social) cash transfer programmes is blurred at best. Both conditions and the ‘no-strings-attached’ version need to be communicated and perceived as such by programme implementers and beneficiaries for the programme to be interpreted as being one or the other. A key distinction found between the cash transfer programmes in Latin America, mostly conditioned, and those in Africa, mostly unconditioned, is the incorporation in the latter of a substantial role for the community in the overall selection of the beneficiaries. The commentary argues that an interesting area for further research would be to look at how this community participation leads to explicit or implicit peer monitoring, and thereby acts in a similar way as a condition does.

Sustainable development: The way for future, where are we?

Sustainable development: The way for future, where are we?

Black's Simple Discounting Rule

We study the implementability of Black's (1988) elegant discounting rule. The rule overcomes thorny problems that traditional valuation approaches struggle with, namely identifying the market portfolio, measuring project risk, and assessing the market risk premium. We offer new theory, showing that the conditional mean cash flow called for in Black's rule equals a given percentile of the cash flow distribution. Moreover, we present evidence that the probability level of the percentile in question is reasonably stationary in time and across countries, and that managers typically have the information our implementation requires. Computing project and firm value with the approach we are proposing is a feasible and theoretically sound alternative to other valuation methods.

Conditional cash and in‐kind transfers increase household total and food consumption in poor rural communities in Mexico.

Conditional cash and in‐kind transfers increase household total and food consumption in poor rural communities in Mexico.

Conditional cash and in‐kind transfers modestly increase linear growth in preschool children living in poor rural communities in Mexico

Conditional cash and in‐kind transfers modestly increase linear growth in preschool children living in poor rural communities in Mexico