The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25 Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades A multilevel analysis of the effect of Malawi's Social Cash Transfer Pilot Scheme on school-age children's health. HPTN 068: A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa—Study Design and Baseline Results Conditional cash transfers to improve education and health: an ex ante evaluation of Red de Protección Social, Nicaragua. Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Conditional Cash Transfers And Health Of Low-Income Families In The US: Evaluating The Family Rewards Experiment. Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. Cash for Women’s Empowerment? A Mixed-Methods Evaluation of the Government of Zambia’s Child Grant Program Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor. Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya Impact of community-based behaviour-change management on perceived neonatal morbidity: a cluster-randomized controlled trial in Shivgarh, Uttar Pradesh, India. Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme.
Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes ; however , questions remain surrounding design features responsible for impacts . In addition , virtually no evidence exists from the African region . This study explores the impact of Zambia 's Child Grant Program  on a range of maternal health utilization outcomes using a r and omized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012 . Results indicate that while there are no measurable program impacts among the main sample , there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services . The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar setting s to impact maternal health PURPOSE This study investigates the causal effect of Kenya 's  unconditional cash transfer program on  mental health outcomes of young people . METHODS Selected locations in Kenya were r and omly assigned to receive unconditional cash transfers  in the first phase of Kenya 's Cash Transfer Program for orphans and Vulnerable Children . In intervention locations , low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $ 20 in 2007 . In 2011 , 4 years after program onset , data were collected on the psychosocial status for youth aged 15 - 24 years from households in intervention and control locations ( N = 1960 ) . The primary outcome variable was an indicator of depressive symptoms using the 10- question Center for Epidemiologic Studies Depression Scale . Secondary outcomes include an indicator for hopefulness and physical health measures . Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program . RESULTS The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers . Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20 - 24 years and orphans . CONCLUSIONS This study provides evidence that poverty-targeted unconditional cash transfer programs , can improve the mental health of young people in low-income countries The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 Abstract Young women in South Africa are at high risk for HIV infection . Cash transfers offer promise to reduce HIV risk . We present the design and baseline results from HPTN 068 , a phase III , individually r and omized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women . A total of 2533 young women were r and omized to receive a monthly cash transfer conditional on school attendance or to a control group . A number of individual- , partner- , household- and school-level factors were associated with HIV and HSV-2 infection . After adjusting for age , all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association ( aOR 3.05 95 % CI 1.84–5.06 ) . Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa Using baseline data from a r and omized experiment , this article extends and tests in the context of health , the feasibility of a recently proposed reduced form approach to ex ante evaluations of social programs with an application to a  conditional cash transfer program in Nicaragua . It uses a behavioural model to estimate the impact on preventive care utilization outcomes for children younger than 3 years . It vali date s the model with the results of the experiment and then simulates two alternate policy scenarios . The model performs well in predicting the health related outcomes and shows different results for the two sets of policy scenarios . In addition , simulations are also carried out for the school component of the cash transfer program Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children Opportunity  NYC-Family Rewards was the first conditional cash transfer , r and omized controlled trial for low-income families in the United States . From 2007 to 2010 , Family Rewards offered 2,377 New York City families cash transfers  that were conditional upon their investments in education , preventive health care , and parental employment . Their health and other outcomes were compared to those of a  control group of 2,372 families . The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care . It improved parents ' perception of their own health and levels of hope , mainly through improvements in reported financial well-being . While the program 's impacts on physical health were weaker , our study might not have captured effects on chronic disease risk that take longer to accrue . In the context of New York City 's operating social-safety-net programs , conditional cash transfers may have led to positive , albeit modest , improvements in the health of poor families BACKGROUND Effective and scalable HIV prevention for adolescents in sub-Saharan Africa is needed . Cash transfers can reduce HIV incidence through reducing risk behaviours . However , questions remain about their effectiveness within national poverty-alleviation programmes , and their effects on different behaviours in boys and girls . METHODS In this case-control study , we interviewed South African adolescents ( aged 10 - 18 years ) between 2009 and 2012 . We r and omly selected census areas in two urban and two rural districts in two provinces in South Africa , including all homes with a resident adolescent . We assessed household receipt of state-provided child-focused cash transfers , incidence in the past year and prevalence of transactional sex , age-disparate sex , unprotected sex , multiple partners , and sex while drunk or after taking drugs . We used logistic regression after propensity score matching to assess the effect of cash transfers on these risky sexual behaviours . FINDINGS We interviewed 3515 participants ( one per household ) at baseline , and interviewed 3401 at follow-up . For adolescent girls ( n=1926 ) , receipt of a cash transfer was associated with reduced incidence of transactional sex ( odds ratio [ OR ] 0·49 , 95 % CI 0·26 - 0·93 ; p=0·028 ) , and age-disparate sex ( OR 0·29 , 95 % CI 0·13 - 0·67 ; p=0·004 ) , with similar associations for prevalence ( for transactional sex , OR 0·47 , 95 % CI 0·26 - 0·86 ; p=0·015 ; for age-disparate sex , OR 0·37 , 95 % CI 0·18 - 0·77 ; p=0·003 ) . No significant effects were shown for other risk behaviours . For boys ( n=1475 ) , no consistent effects were shown for any of the behaviours . INTERPRETATION National , child-focused cash transfers to alleviate poverty for households in sub-Saharan Africa can substantially reduce unsafe partner selection by adolescent girls . Child-focused cash transfers are of potential importance for effective combination strategies for prevention of HIV . FUNDING UK Economic and Social Research Council , South African National Research Foundation , Health Economics and AIDS Research Division at University of KwaZulu-Natal , South African National Department of Social Development , Claude Leon Foundation , John Fell Fund , Nuffield Foundation , and Regional Interagency Task Team for Children affected by AIDS-Eastern and Southern Africa Summary . — The empowerment of women , broadly defined , is an often-cited objective and benefit of social cash transfer programs in developing countries . Despite the promise and potential of cash transfers to empower women , the evidence supporting this outcome is mixed . In addition , there is little evidence from programs at scale in sub-Saharan Africa . We conducted a mixed- methods evaluation of the Government of Zambia ’s Child Grant Program , a poverty-targeted , unconditional transfer given to mothers or primary caregivers of young children aged zero to five . The quantitative component was a four-year longitudinal clustered-r and omized control trial in three rural districts , and the qualitative component was a one-time data collection involving in-depth interviews with women and their partners stratified on marital status and program participation . Our study found that women in beneficiary households were making more sole or joint decisions ( across five out of nine domains ) ; however , impacts translated into relatively modest increases in the number of decision domains a woman is involved in , on average by 0.34 ( or a 6 % increase over a baseline mean of 5.3 ) . Qualitatively , we found that changes in intrahousehold relationships were limited by entrenched gender norms , which indicate men as heads of household and primary decision makers . However , women ’s narratives showed the transfer increased financial empowerment as they were able to retain control over transfers for household investment and savings for emergencies . We highlight method ological challenges in using intrahousehold decision making as the primary indicator to measure empowerment . Results show potential for unconditional cash transfer programs to improve the financial and intrahousehold status of female beneficiaries , however it is likely additional design components are need for transformational change Objective The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex . Design An unblinded , individually r and omised and controlled trial . Setting 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania . Participants The authors enrolled 2399 participants , aged 18–30 years , including adult spouses . Interventions Participants were r and omly assigned to either a control arm ( n=1124 ) or one of two intervention arms : low-value conditional cash transfer ( eligible for $ 10 per testing round , n=660 ) and high-value conditional cash transfer ( eligible for $ 20 per testing round , n=615 ) . The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections . In the intervention arms , conditional cash transfer payments were tied to negative sexually transmitted infection test results . Anyone testing positive for a sexually transmitted infection was offered free treatment , and all received counselling . Main outcome measures The primary study end point was combined prevalence of the four sexually transmitted infections , which were tested and reported to subjects every 4 months : Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis and Mycoplasma genitalium . The authors also tested for HIV , herpes simplex virus 2 and syphilis at baseline and month 12 . Results At the end of the 12-month period , for the combined prevalence of any of the four sexually transmitted infections , which were tested and reported every 4 months ( C trachomatis , N gonorrhoeae , T vaginalis and M genitalium ) , unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 ( 95 % CI 0.54 to 1.06 ) and the adjusted RR was 0.73 ( 95 % CI 0.47 to 0.99 ) . Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 ( 95 % CI 0.49 to 1.03 ) and the adjusted RR was 0.69 ( 95 % CI 0.45 to 0.92 ) . No harm was reported . Conclusions Conditional cash transfers used to incentivise safer sexual practice s are a potentially promising new tool in HIV and sexually transmitted infections prevention . Additional larger study would be useful to clarify the effect size , to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively . Trial registration number NCT00922038 Clinical Trials.gov BACKGROUND Caesarean section rates are increasing in Mexico and Latin America . This study evaluates the impact of a large-scale , conditional cash transfer programme in Mexico on caesarean section rates . The programme provides cash transfers to participating low income , rural households in Mexico conditional on accepting health care and nutrition supplements . METHODS The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Using multivariate and instrumental variable analyses , we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting . Programme participation is measured by beneficiary status , programme months and cash transfers . RESULTS More than two-thirds of poor rural women delivered in a health facility . Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates ; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for > or=6 months before delivery . Beneficiaries had significantly higher caesarean delivery rates in social security facilities ( 24.0 compared with 5.6 % among non-beneficiaries ) and in other government facilities ( 19.3 compared with 9.5 % ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities . This effect appears to be driven by the increases in disposable income from the cash transfer . These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements Objective To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements . Data sources Nairobi Urban Health and Demographic Surveillance System ( NUHDSS ) and two cross-sectional household surveys in Korogocho and Viw and ani informal settlements in 2004–05 and 2006–08 . Methods Odds of facility-based delivery were estimated before and after introduction of an output-based voucher . Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations , a non-voucher outpatient service . As part of NUHDSS , households in Korogocho and Viw and ani reported place of delivery and the presence of a skilled birth attendant ( 2003–10 ) and vaccination coverage ( 2003–09 ) . A detailed maternal and child health ( MCH ) tool was added to NUHDSS ( September 2006–10 ) . Prospect i ve enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006 . In addition to recording mother ’s place of delivery , NUHDSS-MCH recorded the use of the voucher . Findings There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch . Testing whether unrelated outpatient care also increased , a falsification exercise found no significant increase in immunizations for children 12–23 months of age in the same period . Although the proportion completing any antenatal care ( ANC ) visit remained above 95 % of all reported pregnancies and there was a significant increase in facility-based deliveries , the proportion of women completing 4 + ANC visits was significantly lower during the voucher programme . Conclusions A positive association was observed between vouchers and facility-based deliveries in Nairobi . Although there is a need for higher quality evidence and validation in future studies , this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved population In the context of high neonatal mortality rate ( NMR ) in developing country setting s , a promising strategy for enhancing newborn health is promotion of preventive newborn care practice s. We measured the effect of a behaviour-change intervention on perceived neonatal illnesses in rural Uttar Pradesh , India . The study was nested in a cluster-r and omized controlled trial of the impact of a package of essential newborn care on NMR . We prospect ively enrolled 802 mothers and administered a question naire on perceived neonatal morbidities . Regression analysis showed that newborns in the intervention clusters had significantly lower risk of perceived diarrhoea [ adjusted relative risk ( aRR ) 0.67 , 95 % confidence interval ( CI ) 0.49 - 0.90 ] and skin-related complications [ aRR 0.67 , 95 % CI 0.45 - 1.00 ] compared to newborns in the comparison area . Assuming incidence of perceived illnesses is a proxy for actual morbidity rates , we conclude that promotion of preventive care practice s through behaviour-change interventions was effective in reducing neonatal morbidities OBJECTIVES To evaluate the impact of Mexico 's conditional cash transfer programme on the quality of health care received by poor women . Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines . METHODS The data describe retrospective reports of care received from 892 women in poor rural communities in seven Mexican states . The women were participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 . Eligible women accepted cash transfers conditional on obtaining health care and nutritional supplements , and participated in health education sessions . RESULTS Oportunidades beneficiaries received 12.2 % more prenatal procedures compared with non-beneficiaries ( adjusted mean 78.9 , 95 % Confidence Interval ( CI ) : 77.5 - 80.3 ; P < 0.001 ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with better quality of prenatal care for low-income , rural women in Mexico . This result is probably a manifestation of the programme 's empowerment goal , by encouraging beneficiaries to be informed and active health consumers
The review found that CTs can be effective in tackling structural determinants of health such as financial poverty , education , household resilience , child labour , social capital and social cohesion , civic participation , and birth registration .
The review further found that CTs modify intermediate determinants such as nutrition , dietary diversity , child deprivation , sexual risk behaviours , teen pregnancy and early marriage .
In conjunction with their influence on SDoH , there is moderate evidence from the review that CTs impact on health and quality of life outcomes .
The review also found many factors relating to intervention design features , macro-economic stability , household dynamics and community acceptance of programs that could influence the effectiveness of CTs .
The external validity of the review findings is strong as the findings are largely consistent with those from Latin America .
Cash transfers ( CTs ) are now high on the agenda of most governments in low- and middle-income countries .
Within the field of health promotion , CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health ( SDoH ) and health inequalities .
A systematic review was conducted to synthesis e the evidence on CTs ' impacts on SDoH and health inequalities in sub-Saharan Africa , and to identify the barriers and facilitators of effective CTs .