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      Conditional cash transfers and the creation of equal opportunities of health for children in low and middle-income countries: a literature review

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          Abstract

          Introduction

          Conditional Cash Transfers (CCTs) have been largely used in the world during the past decades, since they are known for enhancing children’s human development and promoting social inclusion for the most deprived groups. In other words, CCTs seek to create life chances for children to overcome poverty and exclusion, thus reducing inequality of opportunity. The main goal of the present article is to identify studies capable of showing if CCTs create equality of opportunity in health for children in low and middle-income countries.

          Methodology

          Comprehensive literature searches were conducted in the Academic Search Complete (EBSCO), PubMed/Medline, Scopus and Web of Science electronic bibliographic databases. Relevant studies were searched using the combination of key words (either based on Medical Subject Headings (MeSH) terms or free text terms) related to conditional cash transfers, child health and equality of opportunity. An integrative research review was conducted on 17 quantitative studies.

          Results

          The effects of CCTs on children’s health outcomes related to Social Health Determinants were mostly positive for immunization rates or vaccination coverage and for improvements in child morbidity. Nevertheless, the effects of CCTs were mixed for the child mortality indicators and biochemical or biometric health outcomes.

          Conclusions

          The present literature review identified five CCTs that provided evidence regarding the creation of health opportunities for children under 5 years old. Nevertheless, cash transfers alone or the use of conditions may not be able to mitigate poverty and health inequalities in the presence of poor health services.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12939-017-0647-2) contains supplementary material, which is available to authorized users.

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          Most cited references21

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          India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation.

          In 2005, with the goal of reducing the numbers of maternal and neonatal deaths, the Government of India launched Janani Suraksha Yojana (JSY), a conditional cash transfer scheme, to incentivise women to give birth in a health facility. We independently assessed the effect of JSY on intervention coverage and health outcomes. We used data from the nationwide district-level household surveys done in 2002-04 and 2007-09 to assess receipt of financial assistance from JSY as a function of socioeconomic and demographic characteristics; and used three analytical approaches (matching, with-versus-without comparison, and differences in differences) to assess the effect of JSY on antenatal care, in-facility births, and perinatal, neonatal, and maternal deaths. Implementation of JSY in 2007-08 was highly variable by state-from less than 5% to 44% of women giving birth receiving cash payments from JSY. The poorest and least educated women did not always have the highest odds of receiving JSY payments. JSY had a significant effect on increasing antenatal care and in-facility births. In the matching analysis, JSY payment was associated with a reduction of 3.7 (95% CI 2.2-5.2) perinatal deaths per 1000 pregnancies and 2.3 (0.9-3.7) neonatal deaths per 1000 livebirths. In the with-versus-without comparison, the reductions were 4.1 (2.5-5.7) perinatal deaths per 1000 pregnancies and 2.4 (0.7-4.1) neonatal deaths per 1000 livebirths. The findings of this assessment are encouraging, but they also emphasise the need for improved targeting of the poorest women and attention to quality of obstetric care in health facilities. Continued independent monitoring and evaluations are important to measure the effect of JSY as financial and political commitment to the programme intensifies. Bill & Melinda Gates Foundation. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades.

            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 designed 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. In an intervention that began in 1998 in Mexico, low-income communities (n=506) were randomly 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. 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. Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health, growth, and development.
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              Conditional cash transfers and health: unpacking the causal chain

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                Author and article information

                Contributors
                rebecacbsouza@gmail.com
                leidesm74@gmail.com
                jjsoaresneto@gmail.com
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                31 August 2017
                31 August 2017
                2017
                : 16
                : 161
                Affiliations
                [1 ]ISNI 0000 0001 2238 5157, GRID grid.7632.0, Postgraduate Program of Development, Society and International Cooperation of the Centre of Advanced and Multidisciplinary Studies, , University of Brasilia, ICC Central, ; Bloco B, Mezanino, Offices 357/308, Brasilia, DF 70910-900 Brazil
                [2 ]ISNI 0000 0001 2238 5157, GRID grid.7632.0, Faculty of Health Science and Postgraduate Program of Development, Society and International Cooperation of the Centre of Advanced and Multidisciplinary Studies, , University of Brasilia, ICC Central, ; Bloco B, Mezanino, Offices 357/308, Brasilia, 70910-900 Brazil
                Author information
                http://orcid.org/0000-0002-2030-3434
                Article
                647
                10.1186/s12939-017-0647-2
                5580215
                28859650
                3aa72a87-938f-4a5a-bc35-8c2eb4a48c37
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 September 2016
                : 14 August 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                child health,equality of opportunity,cash transfers,social determinants of health,equity,policy,development

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