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Kelly NK, Bhushan NL, Gottfredson O'Shea N, Gómez-Olivé FX, Aiello AE, Wagner LD, Mall S, Kahn K, Pettifor AE, Stoner MC. Trajectories of intimate partner violence and their relationship to stress among young women in South Africa: An HPTN 068 study. Int J Soc Psychiatry 2024:207640241239535. [PMID: 38563376 DOI: 10.1177/00207640241239535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND One in four South African women will experience intimate partner violence (IPV) in their lifetime, potentially increasing their biological stress. In South Africa, limited IPV and stress research has utilized multiple timepoints or examined modifying factors. Cash transfers (CTs) are associated with reduced IPV and stress and may be an intervention target. AIMS We used data-driven methods to identify longitudinal IPV trajectory groups among South African adolescent girls and young women (AGYW), estimate each group's association with stress, and assess modification by a CT. METHODS A total of 2,183 South African AGYW ages 13 to 24 years from the HIV Prevention Trials Network 068 study were randomized to a CT or control group. Physical IPV was measured five times (2011-2017), and stress was captured once (2018-2019). Stress measures included the Cohen Stress Scale and stress biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)). Group-based trajectory modeling identified IPV trajectories; ordinal logistic regression estimated the association between trajectory group and stress. RESULTS A two-group quadratic trajectory model was identified (higher trajectory group = 26.7% of AGYW; lower trajectory group = 73.3%). In both groups, the probability of IPV increased from ages 13 to 17 years before declining in early adulthood. However, the higher group's probability peaked later and declined gradually. The higher trajectory group was associated with an increased odds of elevated CRP (OR: 1.41, 95% CI [1.11, 1.80]), but not with other stress measures. The CT modified the relationship with CMV: a positive association was observed among the usual care arm (OR: 1.59, 95% CI [1.11, 2.28]) but not the CT arm (OR: 0.85, 95% CI [0.61, 1.19]). CONCLUSIONS Sustained IPV risk during adolescence was associated with elevated CRP in young adulthood. The relationship between IPV and elevated CMV was attenuated among those receiving a CT, suggesting that CTs could possibly reduce biological stress due to IPV.
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Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Nivedita L Bhushan
- Center for Communication and Engagement Research, RTI International, Research Triangle Park, NC, USA
| | - Nisha Gottfredson O'Shea
- Substance Use Prevention, Evaluation, and Research Program, RTI International, Research Triangle Park, NC, USA
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Allison E Aiello
- Department of Epidemiology, Robert N Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Sumaya Mall
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marie Cd Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
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LaPointe S, Mendola P, Lin S, Tian L, Bonell A, Adamba C, Palermo T. Impact of cash transfers on the association between prenatal exposures to high temperatures and low birthweight: Retrospective analysis from the LEAP 1000 study. BJOG 2024; 131:641-650. [PMID: 38238994 DOI: 10.1111/1471-0528.17761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To explore the associations between prenatal temperature exposures and low birthweight (LBW) and modification by cash transfer (CT) receipt. DESIGN Retrospective cohort study. SETTING Five rural districts in Northern Ghana. POPULATION OR SAMPLE A total of 3016 infants born to women interviewed as part of the Livelihood Empowerment Against Poverty (LEAP 1000) impact evaluation between 2015 and 2017. METHODS Birthweight was collected using household surveys administered to LEAP 1000 eligible women. We used a UNICEF-developed multiple imputation approach to address missingness of birthweight and applied an empirical heaping correction to the multiply imputed birthweight data. Survey data were linked to the European Centre for Medium-Range Weather Forecasts Reanalysis 5-hourly temperature averaged to weeks for 2011-2017 using community centroids. Using distributed-lag nonlinear models, we explored the lag-specific associations between weekly average temperatures greater than 30°C and LBW, and stratified by LEAP 1000 treatment. MAIN OUTCOME MEASURES Low birthweight (<2.5 kg). RESULTS Twelve percent (n = 365) of infants were LBW; the mean ± SD birthweight was 3.02 ± 0.37 kg. Overall, increasing temperatures were associated with increased odds of LBW, with the greatest odds observed in the 3 weeks before birth (odds ratio 1.005-1.025). These positive associations were even larger among comparison infants and null among treatment infants. CONCLUSIONS Our study found increased odds of LBW with high weekly average temperatures throughout pregnancy and the preconception period and demonstrate mitigated effects by the LEAP 1000 CT program. More evidence on the potential of CTs to serve as adaptation interventions in low- and middle-income countries is needed to protect pregnant persons and their infants from the impacts of climate change.
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Affiliation(s)
- Sarah LaPointe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ana Bonell
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clement Adamba
- School of Education and Leadership, University of Ghana, Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York, USA
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Ay Kesgin M, Saraç M, Grede N, Çavlin Bircan A, Koç İ. Impact of financial assistance on stunting: Syrian refugee children under 5 in Türkiye. J Biosoc Sci 2024:1-27. [PMID: 38356431 DOI: 10.1017/s0021932024000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Despite the global decrease over the last two decades, stunting, also called 'chronic malnutrition', remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.
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Affiliation(s)
| | - Melike Saraç
- Department of Social Research Methodology, Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Nils Grede
- United Nations World Food Programme, Ankara, Turkey
| | - Alanur Çavlin Bircan
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - İsmet Koç
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Laszlo S, Majid MF, Renée L. Conditional cash transfers and women's reproductive choices. Health Econ 2024; 33:204-228. [PMID: 37845819 DOI: 10.1002/hec.4768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.
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Atake EH, Dandonougbo Y, Gbeasor-Komlanvi FA, Yagninim MAN, Kouevi DK. Impacts of unconditional cash transfers on health care utilisation in informal sector households in Togo. Int J Health Plann Manage 2024; 39:62-82. [PMID: 37816073 DOI: 10.1002/hpm.3715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Most Togolese population earns their income from informal sector, and they are very often exposed to health outcomes. Cash transfers impact healthcare utilization by improving household's social capital, socio-economic status, lifestyle choice, and physical health. The aim of this paper was to analyse the impact of unconditional cash transfers on health care utilisation in informal sector households. METHODS We used the propensity-score method to compare health care utilisation by households that received cash transfers from nonbeneficiary households and simulated a potential confounder to assess the robustness of the impacts of the estimated treatment (i.e., cash transfer). Data were obtained from a national survey that covered 1405 households. RESULTS The results show that women benefited the most from cash transfers (73.1%). Our estimates indicate that health care utilisation increased by 28.3% among workers in the informal sectors who benefited from unconditional cash transfers compared to nonbeneficiaries. The greatest impact was found on agriculture households with an increase by 31.3% in the health care utilisation. In general, cash transfer beneficiaries are more likely to use public health centres; there was an increase in public health facility attendance of 21.3%. CONCLUSIONS Cash transfers are a valuable social protection instrument that improve health care utilisation of populations in the informal sector. Policymakers could use cash transfer as the infusion of income and/or assets that may impact health outcomes. Cash transfers are an opportunity to alleviate barriers of access to health care by older people. Future research must examine impact of cash transfer on health of vulnerable groups such as older people, children, and people with disabilities.
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Affiliation(s)
- Esso-Hanam Atake
- Department of Economics, Faculty of Economics and Management Sciences (FASEG), University of Lomé, Lomé, Togo
| | - Yevessé Dandonougbo
- Department of Agricultural Economics and Rural Sociology, School of Agronomy (ESA), University of Lomé, Lomé, Togo
| | | | - Malb Ama N'Danida Yagninim
- Department of Economics, Faculty of Economics and Management Sciences (FASEG), University of Kara, Kara, Togo
| | - Didier Koumavi Kouevi
- Department of Public Health, Faculty of Health Sciences, University of Lomé, Lomé, Togo
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Aida J, Ishimaru M, Kino S. Reconsidering economic interventions to reduce oral health inequalities. Community Dent Oral Epidemiol 2023; 51:600-605. [PMID: 37282745 DOI: 10.1111/cdoe.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
Despite the general recognition of economic factors as fundamental upstream social determinants of health inequalities, interventions to improve health and reduce inequalities tend to focus on proximal health determinants. However, recent socioeconomic crises have increased the focus on economic factors. Health-related approaches to address economic factors can be divided into two categories: (1) indirect approaches, such as financial support for obtaining dental care and fiscal policies targeting unhealthy commodities and (2) direct approaches, such as cash transfers or provision of a universal basic income. For indirect approaches, policies reducing out-of-pocket payments for dental care appear to improve access to services and reduce oral health inequalities. Price policies targeting tobacco and sugar through taxation are associated with declines in periodontal disease and caries, and sugar taxation appears to reduce oral health inequalities. As regards direct approaches, studies on cash transfers to low-income individuals have found no positive impact on dental visits, while results in relation to caries prevention were inconclusive. No dental studies examined the effect of a population approach to income security, such as basic income. Research on economic interventions for oral health inequalities is scarce, and studies using causal inference methods and natural experiments are urgently needed.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Ishimaru
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Bergenfeld I. Empower People… With Money. Int J Public Health 2023; 68:1605932. [PMID: 37465050 PMCID: PMC10351534 DOI: 10.3389/ijph.2023.1605932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Irina Bergenfeld
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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Chakraborty R, Kobayashi LC, Jock J, Wing C, Chen X, Phillips M, Berkman L, Kahn K, Kabudula CW, Rosenberg M. Child Support Grant expansion and cognitive function among women in rural South Africa: findings from a natural experiment in HAALSI cohort. medRxiv 2023:2023.02.18.23286130. [PMID: 36824712 PMCID: PMC9949209 DOI: 10.1101/2023.02.18.23286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Cash transfers are a promising but understudied intervention that may protect cognitive function in adults by promoting their cognitive reserve. South Africa has a rapidly ageing population, however, less is known about the nature of association between cash transfers and cognitive function in this setting. We leveraged natural experiments from Child Support Grant (CSG) age-eligibility expansions to investigate the association between duration of CSG eligibility and cognitive function among biological mothers of child beneficiaries in South Africa. We analysed 2014/2015 baseline data from 944 women, aged 40 - 59 years with at least one CSG-eligible child, enrolled in the HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age eligibility expansion years. Cognitive function was measured using a cognitive battery administered to the mothers at baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. Our study finds that high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores [β: 0.19 SD; 95% CI: 0.05, 0.34, p-value = 0.02]. Government cash transfers given to support raising children may confer substantial protective effect on cognitive function of mothers in their mid-life. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Maffioli EM, Headey D, Lambrecht I, Oo TZ, Zaw NT. A Prepandemic Nutrition-Sensitive Social Protection Program Has Sustained Benefits for Food Security and Diet Diversity in Myanmar during a Severe Economic Crisis. J Nutr 2023; 153:1052-1062. [PMID: 36792031 DOI: 10.1016/j.tjnut.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND One-third of preschool children in Myanmar were stunted in 2015-2016, and three-quarters of children 6-23 mo had inadequate diet diversity. In response, a large-scale nutrition-sensitive social protection program was implemented over 2016-2019. In 2020, however, Myanmar's economy was hit hard by the COVID-19 pandemic and harder still by a military takeover in 2021. OBJECTIVE The objective of this study was to examine whether former beneficiaries of this program experienced better food security, food consumption, and diet diversity outcomes in the wake of major economic shocks. METHODS In a previous cluster-randomized controlled trial conducted over 2016-2019, pregnant women and their children aged <2 y were randomly assigned to either: 1) CASH; 2) CASH + social and behavioral change communication (SBCC); or 3) a control group. Subsamples of these former participants were then resurveyed 10 times from June 2020 to December 2021 during Myanmar's protracted economic crisis. Randomized treatment exposure was used in a regression analysis to test for postprogram impacts on Food Insecurity Experience Scale indicators, household food consumption, and maternal and child diet diversity. We also examined the impacts on household income as a secondary outcome and potential impact pathway. RESULTS Both intervention arms reported lower food insecurity, more frequent consumption of nutritious foods, and more diverse maternal and child diets compared with households in the control group. However, the improved dietary outcomes were larger for mothers and children exposed to CASH+SBCC compared with CASH, as was their monthly household income. CONCLUSIONS The findings suggest that a program combining cash transfers with nutrition-related education can yield sustained benefits 1-2 y after the program was completed. This strengthens the evidence to support the expansion and scale-up of nutrition-sensitive social welfare programs to redress chronic malnutrition and enhance nutritional resilience in the face of a severe economic crisis. J Nutr 2023;xx:xx-xx.
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Affiliation(s)
- Elisa M Maffioli
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Derek Headey
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Isabel Lambrecht
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Quinones S, Mendola P, Tian L, Lin S, Novignon J, Angeles G, Palermo T. Ghana's Livelihood Empowerment Against Poverty (1000) Program Seasonally Impacts Birthweight: A Difference-in-Differences Analysis. Int J Public Health 2023; 68:1605336. [PMID: 36891221 PMCID: PMC9986251 DOI: 10.3389/ijph.2023.1605336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
Objectives: Low birthweight (LBW) prevalence remains high in African countries and evidence of cash transfer impacts on birthweight, particularly by season of infant birth, is limited. This study examines overall and seasonal cash transfer impacts on LBW in rural Ghana. Methods: Data come from a longitudinal, quasi-experimental impact evaluation of the Livelihood Empowerment Against Poverty (LEAP) 1,000 unconditional cash transfer program for impoverished pregnant or lactating women in rural districts of Northern Ghana. LEAP1000 program impacts on average birthweight and LBW were estimated for a multiply imputed sample of 3,258 and a panel sample of 1,567 infants using differences-in-differences models and triple difference models to assess impacts by season. Results: LEAP1000 decreased LBW prevalence by 3.5 and 4.1 percentage points overall and in the dry season, respectively. LEAP1000 increased average birthweight by 94, 109, and 79 g overall, in the dry season, and in the rainy season, respectively. Conclusion: Our findings of positive LEAP1000 impacts on birthweight across seasons and on LBW in the dry season demonstrate the need to take seasonal vulnerabilities into account when designing and implementing programs for rural populations in Africa.
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Affiliation(s)
- Sarah Quinones
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, United States.,Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, United States
| | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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11
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Zembe-Mkabile W, Sanders D, Ramokolo V, Doherty T. 'I know what I should be feeding my child': foodways of primary caregivers of Child Support Grant recipients in South Africa. Glob Health Action 2022; 15:2014045. [PMID: 35156565 PMCID: PMC8856096 DOI: 10.1080/16549716.2021.2014045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Despite South Africa being an upper middle-income country producing enough food to sustain its population, and having an advanced social welfare system, it has high levels of food insecurity at the household-level. Food insecurity is linked to malnutrition and undernutrition in children. This manuscript addresses gaps in knowledge about food choices and practices of primary caregivers of children in receipt of South Africa's largest cash transfer programme, the Child Support Grant (CSG). OBJECTIVE The main objective of the study was to explore CSG caregivers' foodways and the choices they made about what food to buy, where to buy it and for what reasons, in Langa in the Western Cape and Mt Frere in the Eastern Cape. METHODS We conducted a total of 40 in-depth interviews and 5 focus group discussions with primary caregivers of Child Support Grant recipients younger than 5 years in the Eastern and Western Cape provinces. RESULTS Caregivers' food choices were less influenced by cultural practices and personal preferences, than by financial and physical constraints in terms of what and where to access food. Constraints in food choices were chiefly a consequence of the small amount of the grant, as well as a food environment that only availed foods of a certain quality and type in these low-income communities. CONCLUSIONS The foodways of recipients of social assistance can only be better aligned with nutrition messaging and policy if there are changes in the monetary value of cash transfers, and the food environments of low-income households which determine access to, availability and affordability of nutritious food. Local informal food enterprises play an important role in the food system of CSG recipients and need to be considered in any strategies that seek to reform the food system of low-income communities in South Africa and similar settings.
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Affiliation(s)
- Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Southern African Social Policy Research Institute Cape Town, South Africa.,Archie Mafeje Research Institute, College of Graduate Studies, University of South Africa Pretoria, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - Vundli Ramokolo
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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12
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Durão S, Ramokolo V, Schoonees A, Drimie S. Cochrane corner: community-level interventions to increase access to food in low- and middle-income countries. Pan Afr Med J 2022; 43:163. [PMID: 36825123 PMCID: PMC9941614 DOI: 10.11604/pamj.2022.43.163.35415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
Food insecurity and hunger is a continuing problem in Africa, with access to food being critical to address it. Community-level interventions may help to increase access to food, specifically, nutritious food. We highlight a Cochrane review that assessed community level interventions aiming to increase access to nutritious food in low- and middle-income countries (LMICs), including those that improve buying power, address food prices, and the social environment. Randomised controlled trials and prospective controlled studies that assessed the effects of these interventions on food security and nutritional status were included, providing relevant implications for practice in LMICs. Findings suggest that unconditional cash transfers (UCTs) are important for improving food security, and that UCTs and food vouchers may increase dietary diversity and reduce stunting. This highlights the importance of current programmes in Africa, the need to reflect and refine where needed, and expand their capacity. A holistic approach to address food insecurity in the region.
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Affiliation(s)
- Solange Durão
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa,,Corresponding author: Solange Durão, Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa.
| | - Vundli Ramokolo
- HIV Prevention Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow Valley, Cape Town, 7501, South Africa
| | - Scott Drimie
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow Valley, Cape Town, 7501, South Africa
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Abstract
How much happiness could be gained if the world's wealth were distributed more equally? Despite decades of research investigating the relationship between money and happiness, no experimental work has quantified this effect for people across the global economic spectrum. We estimated the total gain in happiness generated when a pair of high-net-worth donors redistributed US$2 million of their wealth in $10,000 cash transfers to 200 people. Our preregistered analyses offer causal evidence that cash transfers substantially increase happiness among economically diverse individuals around the world. Recipients in lower-income countries exhibited happiness gains three times larger than those in higher-income countries. Still, the cash provided detectable benefits for people with household incomes up to $123,000.
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Affiliation(s)
- Ryan J Dwyer
- Department of Psychology, University of British Columbia, Vancouver V6T 1Z4, BC, Canada
| | - Elizabeth W Dunn
- Department of Psychology, University of British Columbia, Vancouver V6T 1Z4, BC, Canada
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14
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Ohrnberger J. Economic shocks, health, and social protection: The effect of COVID-19 income shocks on health and mitigation through cash transfers in South Africa. Health Econ 2022; 31:2481-2498. [PMID: 35997147 PMCID: PMC9539133 DOI: 10.1002/hec.4592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 caused an unprecedented health and economic crisis. Nation-wide lockdowns triggered major economic disruptions across the world. We provide evidence of the impact of these extreme economic shocks on health outcomes across wealth levels. We further identify if cash transfers can mitigate the negative health effects for the most economically vulnerable. The study focuses on South Africa, an Upper Middle-Income Country with high levels of inequality, a large informal labor market and with low levels of social welfare. Using difference-in-difference estimation (DD) on a longitudinal sample of 6437 South Africans, we find that the lockdown income shock significantly reduces health by 0.2 standard deviations (SD). We find no difference of the effect across wealth quartiles. Exposure to a cash transfer program mitigates the negative health effects for recipients in the lowest wealth quartile to 0.25 SD compared to 0.4 SD for non-recipients. Full mitigation occurs for individuals exposed to an on average higher scale-up of the cash transfer program. Our analysis shows that a lockdown induced income shock caused adverse health outcomes; however, a pro-poor cash transfer program protected the most economically vulnerable from these negative health effects.
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Affiliation(s)
- Julius Ohrnberger
- School of Public HealthDepartment of Infectious Disease EpidemiologyImperial College LondonSt Mary's CampusLondon
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15
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Rees CA, Cleon D, Davis AB, Sammy AM, Britto CD, Massaquoi W, Forkpa OW, Johnson AJ, Hook VF, MaCauley JA, Pewu GF, Gorpue M, Gborie A, Brown TT, Fannieh A, Dweh T, Marley RB, Baysah MK, Nowine NN, Niescierenko M, Zaizay L. Cash transfers and nutrition education to improve dietary diversity among children aged 6-23 months in Grand Gedeh County, Liberia: a cluster-randomized trial. J Trop Pediatr 2022; 68:6814389. [PMID: 36350714 DOI: 10.1093/tropej/fmac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a cash transfer and nutrition education program on dietary diversity among children in Liberia. We hypothesized that a multi-pronged intervention would result in improved dietary diversity among children. METHODS We conducted a three-armed, cluster-randomized study in 42 communities (12 children per community) in Grand Gedeh County, Liberia, over a 12-month period. We randomly assigned communities to control (n = 14 communities), those that received both bimonthly cash transfers and a structured nutrition education program (n = 14 communities) and those that received bimonthly cash transfers alone (n = 14 communities). Community health assistants conducted bimonthly assessments in participants' homes. The primary outcome was the proportion of children aged 6-23 months who met minimum dietary diversity score (i.e., ≥4 food groups consumed per day). Secondary outcomes included meal frequency and healthcare utilization for illnesses (NCT04101487). RESULTS There were 599 children enrolled; 533 (88.9%) were retained through the trial period. The proportion of children who consumed ≥4 food groups per day did not differ among the three arms. However, children randomized to receive cash transfers had higher dietary diversity scores than the control group. Children in communities that received cash transfers alone and with nutrition education consumed significantly more meals per day and were less likely to have visits to clinics or hospitals for illnesses than children in control communities. CONCLUSION Bimonthly, unconditional cash transfers and nutrition education were associated with higher dietary diversity scores, greater meal frequency, and fewer healthcare visits for illnesses among children aged 6-23 months.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Dadah Cleon
- Independent Consultant, Ministry of Health Liberia, Monrovia 9009, Liberia
| | | | - Andrew M Sammy
- UNICEF Papua New Guinea, Port Moresby 472, Papua New Guinea
| | | | | | | | - Andrew J Johnson
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Varla F Hook
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Jane A MaCauley
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Garbie F Pewu
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Mercy Gorpue
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Amos Gborie
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Trokon T Brown
- National Public Health Institute of Liberia, Monrovia 777P+866, Liberia
| | - Augustine Fannieh
- Grand Gedeh County Health Team, Ministry of Health Liberia, Monrovia 9009, Liberia
| | - Teeline Dweh
- Grand Gedeh County Health Team, Ministry of Health Liberia, Monrovia 9009, Liberia
| | - Ruth B Marley
- Grand Gedeh County Health Team, Ministry of Health Liberia, Monrovia 9009, Liberia
| | - Massaboi K Baysah
- Grand Gedeh County Health Team, Ministry of Health Liberia, Monrovia 9009, Liberia
| | - Netus N Nowine
- Grand Gedeh County Health Team, Ministry of Health Liberia, Monrovia 9009, Liberia
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16
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Nyati LH, Patel L, Haffejee S, Sello M, Mbowa S, Sani T, Norris SA. Context Matters-Child Growth within a Constrained Socio-Economic Environment. Int J Environ Res Public Health 2022; 19:11944. [PMID: 36231238 PMCID: PMC9564395 DOI: 10.3390/ijerph191911944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Communities in major cities in developing countries may experience economic vulnerability, which has detrimental consequences for maternal and child health. This study investigated individual-, household-, and community-level factors associated with child growth and resilience of early-grade learners aged 6 to 8 years. Demographic characteristics, depression scale, child wellbeing, and anthropometric measurements were collected on a sample of 162 caregiver-child pairs (children 46% female) who receive the child support grant (cash transfer programme) from five low-income urban communities in the City of Johannesburg, South Africa. Height and weight were converted to z-scores using the WHO Anthroplus software. Multiple linear regression was used to assess factors associated with child health outcomes and multi-level regression to account for community-level factors. Higher income vulnerability was associated with lower weight- and height-for-age z-scores (WAZ and HAZ). Not completing secondary schooling and higher household size were associated with lower HAZ but higher BAZ. Child male sex and caregiver with depression were associated with lower child resilience. Caregiver's level of schooling and household size remained independent predictors of child growth, while the caregiver's mental health status independently predicted child resilience. Thus, notwithstanding systemic constraints, there may be modifiable drivers that can help in developing targeted intervention.
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Affiliation(s)
- Lukhanyo H. Nyati
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Parktown, Johannesburg 2193, South Africa
| | - Leila Patel
- Centre for Social Development in Africa, Faculty of Humanities, Johannesburg Business School, University of Johannesburg, Milpark 2092, South Africa
| | - Sadiyya Haffejee
- Centre for Social Development in Africa, Faculty of Humanities, Johannesburg Business School, University of Johannesburg, Milpark 2092, South Africa
| | - Matshidiso Sello
- Centre for Social Development in Africa, Faculty of Humanities, Johannesburg Business School, University of Johannesburg, Milpark 2092, South Africa
| | - Sonia Mbowa
- Centre for Social Development in Africa, Faculty of Humanities, Johannesburg Business School, University of Johannesburg, Milpark 2092, South Africa
| | - Tania Sani
- Centre for Social Development in Africa, Faculty of Humanities, Johannesburg Business School, University of Johannesburg, Milpark 2092, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Parktown, Johannesburg 2193, South Africa
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17
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Novignon J, Prencipe L, Molotsky A, Valli E, de Groot R, Adamba C, Palermo T. The impact of unconditional cash transfers on morbidity and health-seeking behaviour in Africa: evidence from Ghana, Malawi, Zambia and Zimbabwe. Health Policy Plan 2022; 37:607-623. [PMID: 35157775 PMCID: PMC9113146 DOI: 10.1093/heapol/czac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/21/2021] [Accepted: 02/11/2022] [Indexed: 11/12/2022] Open
Abstract
Unconditional cash transfers have demonstrated widespread, positive impacts on consumption, food security, productive activities and schooling. However, the evidence to date on cash transfers and health-seeking behaviours and morbidity is not only mixed, but the evidence base is biased towards conditional programmes from Latin America and is more limited in the context of Africa. Given contextual and programmatic design differences between the regions, more evidence from Africa is warranted. We investigate the impact of unconditional cash transfers on morbidity and health-seeking behaviour using data from experimental and quasi-experimental study designs of five government cash transfer programs in Ghana, Malawi, Zambia and Zimbabwe. Programme impacts were estimated using difference-in-differences models with longitudinal data. The results indicate positive programme impacts on health seeking when ill and on health expenditures. Our findings suggest that while unconditional cash transfers can improve health seeking when ill, morbidity impacts were mixed. More research is needed on longer-term impacts, mechanisms of impact and moderating factors. Additionally, taken together with existing evidence, our findings suggest that when summarizing the impacts of cash transfers on health, findings from conditional and unconditional programmes should be disaggregated.
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Affiliation(s)
- Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Leah Prencipe
- Department of Public Health, Erasmus Medical Center, Rotterdam 3000 CA, The Netherlands
| | - Adria Molotsky
- American Institutes for Research, International Development Division, 1400 Crystal Drive, 10th Floor Arlington, VA 22202, USA
| | - Elsa Valli
- UNICEF Office of Research – Innocenti, Via degli Alfani 58, 50121 Florence, Italy
| | - Richard de Groot
- Independent Consultant, Josef Israelshof 23, Oosterhout 4907 PT, The Netherlands
| | - Clement Adamba
- Institute of Statistical, Social and Economic Research, University of Ghana-Legon, P.O. Box LG 74, Legon-Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, 270 Farber Hall, Buffalo, NY 14214-800, USA
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18
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Lassa JA, Nappoe GE, Sulistyo SB. Creating an institutional ecosystem for cash transfer programmes in post-disaster settings: A case from Indonesia. Jamba 2022; 14:1046. [PMID: 35401940 PMCID: PMC8991091 DOI: 10.4102/jamba.v14i1.1046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
Humanitarian and disaster management actors have increasingly adopted cash transfer as an approach to reduce the suffering and vulnerability of the survivors. Cash transfers have also been used as a key instrument in the current coronavirus disease 2019 (COVID-19) pandemic. This article uses an exploratory research strategy to understand how non-governmental organisations (NGOs) and governments implement humanitarian cash transfer in a post-disaster setting. This article asks: what are the institutional constraints and opportunities faced by humanitarian emergency responders in ensuring an effective humanitarian cash transfer, and how do humanitarian actors address such institutional constraints? In this article, we have introduced a new conceptual framework, namely the humanitarian and disaster management ecosystem for cash transfer. This framework allows non-governmental actors to restore complex relations amongst state, disaster survivors (citizen), local market economy and civil society. Mixed methods and multistage research strategies were used to collect and analyse primary and secondary data. The authors conclude that by implementing cash transfers in the context of post-tsunamigenic earthquakes and liquefaction hazards, NGOs must co-create an ecosystem of response that aims to restore disaster-affected people’s access to cash and basic needs. However, in order to ensure such access to basic needs, the responders must first restore relations between the states and their citizens before linking the at-risk communities with the private sectors to jump-start local livelihoods and market economy.
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Affiliation(s)
- Jonatan A Lassa
- Northern Institute, Charles Darwin University, Darwin, Australia
| | - Gisela E Nappoe
- Institute of Resource Governance and Social Change, Kupang, Indonesia
| | - Susilo B Sulistyo
- Social Protection Program, Wahana Visi Indonesia, Jakarta, Indonesia
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19
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Orkin K, Garlick R, Rodriguez Hurtado I, Grabowska M, Kreft B, Cahill A. International evidence to inform decision making on implementing urgent response social protection measures. PSYCHOL HEALTH MED 2022; 27:219-238. [PMID: 35920690 DOI: 10.1080/13548506.2022.2108088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper summarises evidence from a rapid review of international findings on the effects of cash transfers. The learnings were used to inform the design of urgent response social protection during the COVID-19 pandemic. The summary demonstrates that in response to widespread disruption, cash transfers have broad benefits for children, adults, and the wider economy. First, cash grants for child support have been shown to reduce hunger, increase dietary diversity, and reduce secondary school dropout. Transfers may also reduce child malnutrition. Second, there is some evidence that cash grants could encourage job search and economic activity. By contrast, there is little evidence that grants discourage adults from working, or increase spending on temptation goods (alcohol, tobacco). Third, for the wider economy, there is little evidence that grants will increase inflation, while some studies find that transfers create a fiscal multiplier and stimulate the local economy. Finally, we review evidence on design considerations and find that unconditional cash transfers (UCTs) are particularly well suited to rapid response when compared to conditional cash transfers (CCTs). Outside crisis settings, there is some evidence that getting recipients to enrol children in school or attend health check-ups improves these outcomes more than unconditional grants. However, the differences are small and the additional costs of implementing conditions outweigh these benefits in circumstances where response is required urgently. Comparing evidence on cash grants and food vouchers suggests both achieve similar improvements in nutrition; however, cash transfers are likely to be more cost-effective for governments, especially where a system to distribute grants is already set up.
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Affiliation(s)
- Kate Orkin
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Robert Garlick
- Department of Economics, Duke University, Durham, NC, USA
| | | | - Marta Grabowska
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Brynde Kreft
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Alice Cahill
- Blavatnik School of Government, University of Oxford, Oxford, UK
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20
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Chipanta D, Stöckl H, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Estill J, Keiser O. Facing the quality of life: physical illness, anxiety, and depression symptoms among people living with HIV in rural Zambia - a cross-sectional study. AIDS Care 2021; 34:957-965. [PMID: 34383600 DOI: 10.1080/09540121.2021.1966693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Widespread access to ART has not improved the quality of life (QoL) for people living with HIV (PLHIV). We used the United Nations Disability project (UNPRPD) evaluation data to examine how physical illness, anxiety, and depression shape the QoL of PLHIV in households receiving the social cash transfers safety nets in Luapula, Zambia. We explored associations between each outcome - physical illness, anxiety, depression symptoms - and age, gender, poverty, hunger and disability, using univariable and multivariable regressions. We adjusted p-values for multiple hypothesis testing with sharpened Qs. The sample comprised 1925 respondents 16-55 years old, median age 31 (IQR 22-42 years), majority women (n = 1514, 78.6%). Two-thirds (1239, 64.4%) reported having a physical illness, a third (671, 34.9%) anxiety, and nine per cent (366) depression symptoms. More HIV positive people had a disability (34.6%, 53 versus 28.3%, 502; Q = 0.033), were physically ill (72.5%, 111 versus 63.7%, 1128; Q = 0.011), and two-fold (aOR 1.97 95% CI 1.31-2.94) more likely to report depression symptoms than HIV negative peers. Food insecurity and disability among PLHIV may worsen their physical illnesses, anxiety, depression symptoms, and other QoL domains. More research on the quality of life of PLHIV in poverty is required.
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology Medical Faculty, Ludwig Maximilians University, München, Germany
| | - Elona Toska
- Department of Sociology, University of Cape Town, Rondebosch, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia.,Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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21
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Cetinoglu T, Yilmaz V. A contextual policy analysis of a cash programme in a humanitarian setting: the case of the Emergency Social Safety Net in Turkey. Disasters 2021; 45:604-626. [PMID: 32311111 DOI: 10.1111/disa.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Emergency Social Safety Net (ESSN) programme, which was launched in 2016, has become the central element of the humanitarian response to the plight of Syrian refugees in Turkey and an instrument of European migration control policies. This paper offers a contextual analysis of this European Union-funded cash assistance scheme by examining the modes of interaction between its major assumptions and the broader humanitarian response in the context of Turkey. It finds that the ESSN comes with compromises on humanitarian principles and standards, amplifies the protection and assistance divide, and fails to address the realities of Turkey with respect to the country's housing and labour markets and weak protection framework. The paper concludes that a more inclusive approach to eligibility and higher transfer payments can contribute to the addressing of assistance needs provided that cash support is combined with robust protection programming and the implementation of sector-specific projects and policies.
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Affiliation(s)
- Talita Cetinoglu
- Lecturer, Globalisation Studies and Humanitarian Action, Centre for International Relations, Department of International Relations and International Organization, University of Groningen, the Netherlands
| | - Volkan Yilmaz
- Associate Professor of Social Policy, Institute for Graduate Studies in Social Sciences, and Director, Social Policy Forum Research Centre, Bogazici University, Turkey
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22
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Pescarini JM, Williamson E, Ichihara MY, Fiaccone RL, Forastiere L, Ramond A, Nery JS, Penna MLF, Strina A, Reis S, Smeeth L, Rodrigues LC, Brickley EB, Penna GO, Barreto ML. Conditional Cash Transfer Program and Leprosy Incidence: Analysis of 12.9 Million Families From the 100 Million Brazilian Cohort. Am J Epidemiol 2020; 189:1547-1558. [PMID: 32639534 PMCID: PMC7705605 DOI: 10.1093/aje/kwaa127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/23/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023] Open
Abstract
Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations. To test the hypothesis that poverty-alleviating policies might be associated with reduced leprosy incidence, we evaluated the association between the Brazilian Bolsa Familia (BFP) conditional cash transfer program and new leprosy case detection using linked records from 12,949,730 families in the 100 Million Brazilian Cohort (2007–2014). After propensity score matching BFP beneficiary to nonbeneficiary families, we used Mantel-Haenszel tests and Poisson regressions to estimate incidence rate ratios for new leprosy case detection and secondary endpoints related to operational classification and leprosy-associated disabilities at diagnosis. Overall, cumulative leprosy incidence was 17.4/100,000 person-years at risk (95% CI: 17.1, 17.7) and markedly higher in “priority” (high-burden) versus “nonpriority” (low-burden) municipalities (22.8/100,000 person-years at risk, 95% confidence interval (CI): 22.2, 23.3, compared with 14.3/100,000 person-years at risk, 95% CI: 14.0, 14.7). After matching, BFP participation was not associated with leprosy incidence overall (incidence rate ratio (IRR)Poisson = 0.97, 95% CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in high-burden municipalities (IRRPoisson = 0.86, 95% CI: 0.77, 0.96). In high-burden municipalities, the association was particularly pronounced for paucibacillary cases (IRRPoisson = 0.82, 95% CI: 0.68, 0.98) and cases with leprosy-associated disabilities (IRRPoisson = 0.79, 95% CI: 0.65, 0.97). These findings provide policy-relevant evidence that social policies might contribute to ongoing leprosy control efforts in high-burden communities.
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Affiliation(s)
- Julia M Pescarini
- Correspondence to Dr. Julia M. Pescarini, Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, R. Mundo, 121 – Trobogy, CEP 41301-110, Salvador, Brazil (e-mail: )
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Abstract
Violence against children and adolescents, a highly prevalent problem, is a clear violation of child rights and has detrimental effects on later life outcomes. Programs that alleviate poverty address a structural determinant of child vulnerability and can thereby reduce child abuse. This paper investigates whether the Government of Zimbabwe's Harmonized Social Cash Transfer (HSCT) Program, which combines cash transfers with complementary services, affects youth exposure to physical violence. The analysis uses data from a non-experimental impact evaluation and a difference-in-differences approach. Results show a 19-percentage point decline in the incidence of physical violence among youth four years into the program. HSCT-induced enhancements in beneficiary households' purchasing capacity and food security, improvements in caregiver subjective well-being, and reductions in youth participation in economic work for pay could be mediating the program's effects on youth abuse. This paper adds to the relatively scarce evidence on the impacts of anti-poverty policies on young people's susceptibility to physical violence in developing countries.
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Affiliation(s)
- Averi Chakrabarti
- Department of Global Health and Population, T.H. Chan School of Public Health, Harvard University, 90 Smith Street, Boston, MA 02120
| | - Sudhanshu Handa
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH)
| | - Gustavo Angeles
- Department of Maternal & Child Health, Gillings School of Global Public Health, UNC-CH
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24
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Gerard F, Imbert C, Orkin K. Social protection response to the COVID-19 crisis: options for developing countries. Oxford Review of Economic Policy 2020; 36:graa026. [PMCID: PMC7499734 DOI: 10.1093/oxrep/graa026] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The public health response to COVID-19 in many countries has involved strict restrictions on movement and economic activity which threaten the livelihoods of economically vulnerable households. In response, governments are adopting emergency economic measures to provide households with some safety net. We provide an overview of the policies that could form a comprehensive social protection strategy in low-income and middle-income countries, with examples of specific policies that have been adopted. Our core argument is that these countries can cast an emergency safety net with extensive coverage if they use a broader patchwork of solutions than higher-income countries. These strategies could include expanding their social insurance system, building on existing social assistance programmes, and involving local governments and non-state institutions to identify and assist vulnerable groups who are otherwise harder to reach.
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Khan GN, Kureishy S, Ariff S, Habib MA, Usmani AA, Mubarik A, Hussain M, Akbar N, Rodriguez de Castro P, Garzon AC, de Pee S, Soofi SB. Specialized Nutritious Food Combined With Cash Transfers and Social and Behavior Change Communication to Prevent Stunting Among Children Aged 6 to 23 Months in Pakistan: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19001. [PMID: 32831183 PMCID: PMC7477667 DOI: 10.2196/19001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background In Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the past two decades, with the stunting rate being 40.2% in 2018. Children living in rural areas and in the poorest households suffer the most from stunting across the country—43.2% in rural areas and 51.4% in the lowest wealth quintile. As a continuing public health concern, it is essential that stunting prevention is a national priority in order to ensure human capital development, especially among the poorest households. Objective The primary objective of this study is to determine the effect of a medium quantity of a lipid-based nutrient supplement (LNS) combined with unconditional cash transfers and social and behavior change communication (SBCC) on reduction of stunting in children aged 6 to 23 months. Methods A 5-arm cluster randomized controlled trial will be conducted in the district of Rahim Yar Khan in Punjab, Pakistan. The intervention packages will be (1) cash only, (2) cash with LNS, (3) cash with SBCC, and (4) cash with SBCC and LNS. The control arm will receive routine standard of care. We will enroll children at 6 months of age and follow up on a monthly basis up to 24 months of age. A total of 2000 children, 400 in each arm, will be enrolled to detect a 20% reduction in the prevalence of stunting among children aged 24 months. Length, weight, food intake, compliance to interventions, morbidities, and other relevant data will be collected at enrollment and on a monthly basis over the period of 18 months. The process evaluation will assess acceptability of the interventions and potential barriers to implementation through focus group discussions and in-depth interviews with the target population and relevant stakeholders. Furthermore, a cost analysis will be conducted to assess the cost-effectiveness of each intervention package. Results The study protocol was approved by the Ethics Review Committee of Aga Khan University in Pakistan on January 4, 2017. Data collection began in May 2017 and was completed in July 2019. Data analyses are yet to be completed. This study will explore the effectiveness of intervention packages comprised of cash transfers from Benazir Income Support Programme with or without additional LNS and SBCC in preventing childhood stunting. We expect the results to be published in peer-reviewed journals by autumn of 2020. Conclusions The findings of this trial will provide robust evidence as to which intervention packages can have significant effects on linear growth of children and design effective intervention packages to prevent stunting in children aged 6 to 23 months. Trial Registration ClinicalTrials.gov NCT03299218; https://clinicaltrials.gov/ct2/show/NCT03299218 International Registered Report Identifier (IRRID) DERR1-10.2196/19001
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Affiliation(s)
- Gul Nawaz Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Masawar Hussain
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Naveed Akbar
- Benazir Income Support Programme, Government of Pakistan, Islamabad, Pakistan
| | | | | | | | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Ivaschenko O, Doyle J, Kim J, Sibley J, Majoka Z. Does 'Manna from Heaven' help? The role of cash transfers in disaster recovery-lessons from Fiji after Tropical Cyclone Winston. Disasters 2020; 44:455-476. [PMID: 31583740 DOI: 10.1111/disa.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper contributes to the evidence on the effectiveness of shock-responsive social protection systems in helping affected households recover from the negative consequences of disasters. It evaluates the influence of the top-up cash transfers provided by the Government of Fiji to poor households in the wake of Tropical Cyclone Winston, which struck the Pacific Island country on 20 February 2016. The impact evaluation strategy incorporates a sharp regression discontinuity design to define treatment and control groups, based on the eligibility threshold of the poverty benefit scheme. The results indicate that treatment households-that is, those that received cash transfers-are significantly more likely to report quicker recovery from various shocks. Female-headed households are more likely to recover from the ramifications, whereas households with older heads are less likely to do so. The presence of a functioning market appears to be a major factor aiding the speed of recovery. Finally, the evidence points towards strong district effects on recovery.
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Abstract
Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs’ evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation.
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Affiliation(s)
- Ebenezer Owusu-Addo
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.,Bureau of Integrated Rural Development, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, KNUST-Kumasi, Ghana
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Abstract
Households in poor countries are encouraged (and sometimes coerced) to increase investments in formal health care services during pregnancy and childbirth. Is this good policy? The answer to a large extent depends on its effects on child welfare. We study the effects of a cash transfer program in Nigeria in which households were offered a payment of $14 conditioned on uptake of health services. We show that the transfer led to a large increase in uptake and a substantial increase in child survival driven by a decrease in in-utero child deaths. We present evidence suggesting that the key driver is prenatal health investments.
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Affiliation(s)
- Edward N Okeke
- Department of Economics, Sociology and Statistics, RAND, 1200 South Hayes, Arlington, VA 22202
| | - Isa S Abubakar
- Department of Community Medicine, Bayero University Kano and Aminu Kano Teaching Hospital
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29
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Lees S, Kyegombe N, Diatta A, Zogrone A, Roy S, Hidrobo M. Intimate Partner Relationships and Gender Norms in Mali: The Scope of Cash Transfers Targeted to Men to Reduce Intimate Partner Violence. Violence Against Women 2020; 27:447-469. [PMID: 31992148 DOI: 10.1177/1077801219897853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mali has implemented the Filets Sociaux (Jigisémèjiri) program that aims to reduce poverty through cash transfers (CTs) to predominantly male heads of household with accompanying measures. This paper reports on a qualitative study of the effects of the program on intimate partner relationships. In-depth interviews were conducted with men and women in monogamous and polygamous households. Findings revealed that the positive aspects of intimate partner relationships were communication and shared values. However, discussions around decision-making revealed male authority with limited influence by women. Physical violence was reported to be caused by tensions and disputes. Whereas sexual violence was contested, some women described sexual force as violence but men and women asserted that compliance in sexual matters by women was expected. Men also asserted control through preventing women from working outside the home. The CTs were managed by the husband, with some involvement of wives in decision-making about the use of CTs. CTs were reported to reduce household poverty and improve wellbeing, especially for men. There were reports of the effects of the program on IPV, especially in the reduction of physical violence, its effects on sexual violence and controlling behaviour were reported to be limited. Since women are not the primary recipients of the CT, there is limited effect on women's agency to challenge male authority and control around sexual and financial matters. CTs may be more effective if targeted to women, alongside skill and knowledge strengthening to utilize cash transfers to assert their rights to equality and prevent violence.
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Affiliation(s)
- Shelley Lees
- London School of Hygiene & Tropical Medicine, UK
| | | | - Ampa Diatta
- International Food Policy Research Institute, Washington, DC, USA
| | - Amanda Zogrone
- International Food Policy Research Institute, Washington, DC, USA
| | - Shalini Roy
- International Food Policy Research Institute, Washington, DC, USA
| | - Melissa Hidrobo
- International Food Policy Research Institute, Washington, DC, USA
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Palermo TM, Valli E, Ángeles-Tagliaferro G, de Milliano M, Adamba C, Spadafora TR, Barrington C. Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana's National Health Insurance Scheme. BMJ Open 2019; 9:e028726. [PMID: 31690603 PMCID: PMC6858157 DOI: 10.1136/bmjopen-2018-028726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana's Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment. SETTING The study was conducted in five districts implementing Ghana's LEAP 1000 programme in Northern and Upper East Regions. PARTICIPANTS Women, from LEAP households, who were pregnant or had a child under 1 year and who participated in baseline and 24-month surveys (2497) participated in the study. INTERVENTION LEAP provides bimonthly cash payments combined with a premium waiver for enrolment in NHIS to extremely poor households with orphans and vulnerable children, elderly with no productive capacity and persons with severe disability. LEAP 1000, the focus of the current evaluation, expanded eligibility in 2015 to those households with a pregnant woman or child under the age of 12 months. Over the course of the study, households received 13 payments. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included current and ever enrolment in NHIS. Secondary outcomes include reasons for not enrolling in NHIS. We conducted a mixed-methods impact evaluation using a quasi-experimental design and estimated intent-to-treat impacts on health insurance enrolment among children and adults. Longitudinal qualitative interviews were conducted with an embedded cohort of 20 women and analysed using systematic thematic coding. RESULTS Current enrolment increased among the treatment group from 37.4% to 46.6% (n=5523) and decreased among the comparison group from 37.3% to 33.3% (n=4804), resulting in programme impacts of 14 (95% CI 7.8 to 20.5) to 15 (95% CI 10.6 to 18.5) percentage points for current NHIS enrolment. Common reasons for not enrolling were fees and travel. CONCLUSION While impacts on NHIS enrolment were significant, gaps remain to maximise the potential of integrated programming. NHIS and LEAP could be better streamlined to ensure poor households fully benefit from both services, in a further step towards integrated social protection. TRIAL REGISTRATION NUMBER RIDIE-STUDY-ID-55942496d53af.
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Affiliation(s)
- Tia M Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Elsa Valli
- Social and Economic Policy Unit, United Nations Children's Fund, Office of Research Innocenti, Firenze, Italy
| | - Gustavo Ángeles-Tagliaferro
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marlous de Milliano
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Clement Adamba
- School of Education and Leadership, University of Ghana, Accra, Ghana
| | | | - Clare Barrington
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kilburn KN, Pettifor A, Edwards JK, Selin A, Twine R, MacPhail C, Wagner R, Hughes JP, Wang J, Kahn K. Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068). J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485746 PMCID: PMC5978692 DOI: 10.1002/jia2.25043] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/12/2017] [Indexed: 01/27/2023] Open
Abstract
Introduction Evidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12 months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV. Methods HPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13–20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N = 2,448) were interviewed at baseline, then at annual follow‐up visits at 12, 24 and 36 months. The total effect of the CCT on IPV was estimated using a GEE log‐binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures. Results We found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59–0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48–0.65] or under no sexual partner in the last 12 months [RR 0.53, CI(95%):0.46–0.60]. Conclusions Results indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.
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Affiliation(s)
| | - Audrey Pettifor
- University of North Carolina, Chapel Hill, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | | | - Amanda Selin
- University of North Carolina, Chapel Hill, United States
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- University of Wollongong, Wollongong NSW, Australia.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - James P Hughes
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, United States.,University of Washington, Seattle, Washington
| | - Jing Wang
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, United States
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
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32
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Pettifor A, Wamoyi J, Balvanz P, Gichane MW, Maman S. Cash plus: exploring the mechanisms through which a cash transfer plus financial education programme in Tanzania reduced HIV risk for adolescent girls and young women. J Int AIDS Soc 2019; 22 Suppl 4:e25316. [PMID: 31328425 PMCID: PMC6643075 DOI: 10.1002/jia2.25316] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/08/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Cash transfers have been promoted as a means to reduce HIV risk for adolescent girls and young women (AGYW) in sub-Saharan Africa. One of the main mechanisms whereby they are hypothesized to reduce risk is by deterring transactional sex. In this paper, we use qualitative methods to explore participant experiences, perspectives and reported behaviours of a cash transfer plus financial education programme among out of school, 15- to 23-year-old AGYWs in rural Tanzania with a focus on partner choice and transactional sex. METHODS We conducted 60 in-depth interviews (IDIs) and 20 narrative timeline interviews with participants of the PEPFAR DREAMS Sauti/WORTH+ cash transfer programme between June 2017 and July 2018. Interviews were taped, transcribed and translated from Kiswahili to English. Transcripts were coded and analysed for key themes. RESULTS We found that participants in a cash transfer plus programme discussed behaviours that could reduce HIV risk through decreasing their dependence on male sex partners. There appeared to be two main mechanisms for this. One, young women discussed the cash transfer providing for basic needs (e.g. food, toiletries) which appeared to reduce their dependence on male sex partners who previously provided these goods (e.g. transactional sex). This experience was more pronounced among the poorest participants. Two, young women discussed how the financial education/business development aspect of the programme empowered them to refuse some sex partners; unmarried women discussed these experiences more than married women. Social support from family and programme mentors appeared to strengthen young women's ability to successful start businesses, produce income and thus be less dependent on partners. CONCLUSIONS The cash transfer programme may have reduced AGYW engagement in transactional sex that occurred to meet basic needs (one form of transactional sex). The financial education/business development and mentorship elements of the programme appeared important in building AGYW agency, self-esteem and future orientation which may support AGYWs in refusing unwanted sex partners. Future cash plus programmes should consider adding or strengthening financial education and job skills training, mentorship and future orientation to see stronger and perhaps sustainable outcomes for HIV prevention.
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Affiliation(s)
- Audrey Pettifor
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Joyce Wamoyi
- National Institute of Medical ResearchMwanzaTanzania
| | - Peter Balvanz
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Margaret W Gichane
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Suzanne Maman
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Gilliland TE, Sanchirico JN, Taylor JE. An integrated bioeconomic local economy-wide assessment of the environmental impacts of poverty programs. Proc Natl Acad Sci U S A 2019; 116:6737-6742. [PMID: 30877257 PMCID: PMC6452722 DOI: 10.1073/pnas.1816093116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A new generation of poverty programs around the globe provides cash payments to poor and vulnerable households. Studies show that these social cash transfer programs create income and welfare benefits for poor households and the local economies where they live. However, this may come at the cost of damaging local environments if cash payments stimulate food production that conflicts with natural resource conservation. Evaluations of the economic impacts of poverty programs do not account for the welfare consequences of environmental impacts, which are potentially large for poor communities closely tied to natural resources. We use an ex-ante policy simulation tool, a bioeconomic local computable general equilibrium model parameterized with microsurvey data, to analyze the expected welfare consequences of environmental degradation caused by a cash transfer program. For a Philippine fishing community that is a net importer of fish, we show that a government cash transfer program initially increases real incomes for all households. However, increased demand for fish leads to a decline in the local fish stock that reduces program benefits. Household groups experience declines in real income benefits of 2-63%, with fishing households suffering the largest declines. Impacts on local fish stocks depend on the extent to which markets link fishing communities to outside regions through trade. Greater market integration can mitigate the fish stock decline, but this reduces the local income benefits of cash transfers.
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Affiliation(s)
- Ted E Gilliland
- Department of Economics, Mount Holyoke College, South Hadley, MA 01075;
| | - James N Sanchirico
- Department of Environmental Science and Policy, University of California, Davis, CA 95616
- Resources for the Future, Washington, DC 20036
| | - J Edward Taylor
- Department of Agricultural and Resource Economics, University of California, Davis, CA 95616
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Ulrichs M, Slater R, Costella C. Building resilience to climate risks through social protection: from individualised models to systemic transformation. Disasters 2019; 43 Suppl 3:S368-S387. [PMID: 30945765 PMCID: PMC6849709 DOI: 10.1111/disa.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article analyses the role of social protection programmes in contributing to people's resilience to climate risks. Drawing from desk-based and empirical studies in Ethiopia, Kenya and Uganda, it finds that social transfers make a strong contribution to the capacity of individuals and households to absorb the negative impacts of climate-related shocks and stresses. They do so through the provision of reliable, national social safety net systems-even when these are not specifically designed to address climate risks. Social protection can also increase the anticipatory capacity of national disaster response systems through scalability mechanisms, or pre-emptively through linkages to early action and early warning mechanisms. Critical knowledge gaps remain in terms of programmes' contributions to the adaptive capacity required for long-term resilience. The findings offer insights beyond social protection on the importance of robust, national administrative systems as a key foundation to support people's resilience to climate risks.
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Affiliation(s)
| | - Rachel Slater
- Professor of International Development, Centre for International Development and TrainingUniversity of WolverhamptonUnited Kingdom
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35
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Harris-Fry HA, Paudel P, Harrisson T, Shrestha N, Jha S, Beard BJ, Copas A, Shrestha BP, Manandhar DS, Costello AMDL, Cortina-Borja M, Saville NM. Participatory Women's Groups with Cash Transfers Can Increase Dietary Diversity and Micronutrient Adequacy during Pregnancy, whereas Women's Groups with Food Transfers Can Increase Equity in Intrahousehold Energy Allocation. J Nutr 2018; 148:1472-1483. [PMID: 30053188 PMCID: PMC6118166 DOI: 10.1093/jn/nxy109] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is scarce evidence on the impacts of food transfers, cash transfers, or women's groups on food sharing, dietary intakes, or nutrition during pregnancy, when nutritional needs are elevated. Objective This study measured the effects of 3 pregnancy-focused nutrition interventions on intrahousehold food allocation, dietary adequacy, and maternal nutritional status in Nepal. Methods Interventions tested in a cluster-randomized controlled trial (ISRCTN 75964374) were "Participatory Learning and Action" (PLA) monthly women's groups, PLA with transfers of 10 kg fortified flour ("Super Cereal"), and PLA plus transfers of 750 Nepalese rupees (∼US$7.5) to pregnant women. Control clusters received usual government services. Primary outcomes were Relative Dietary Energy Adequacy Ratios (RDEARs) between pregnant women and male household heads and pregnant women and their mothers-in-law. Diets were measured by repeated 24-h dietary recalls. Results Relative to control, RDEARs between pregnant women and their mothers-in-law were 12% higher in the PLA plus food arm (log-RDEAR coefficient = 0.12; 95% CI: 0.02, 0.21; P = 0.014), but 10% lower in the PLA-only arm between pregnant women and male household heads (-0.11; 95% CI: -0.19, -0.02; P = 0.020). In all interventions, pregnant women's energy intakes did not improve, but odds of pregnant women consuming iron-folate supplements were 2.5-4.6 times higher, odds of pregnant women consuming more animal-source foods than the household head were 1.7-2.4 times higher, and midupper arm circumference was higher relative to control. Dietary diversity was 0.4 food groups higher in the PLA plus cash arm than in the control arm. Conclusions All interventions improved maternal diets and nutritional status in pregnancy. PLA women's groups with food transfers increased equity in energy allocation, whereas PLA with cash improved dietary diversity. PLA alone improved diets, but effects were mixed. Scale-up of these interventions in marginalized populations is a policy option, but researchers should find ways to increase adherence to interventions. This trial was registered at www.controlled-trials.com as ISRCTN 75964374.
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Affiliation(s)
| | - Puskar Paudel
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
| | | | - Niva Shrestha
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Jha
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
| | - B James Beard
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew Copas
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Bhim P Shrestha
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
| | | | | | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Trenouth L, Colbourn T, Fenn B, Pietzsch S, Myatt M, Puett C. The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan. Health Policy Plan 2018; 33:743-754. [PMID: 29912462 PMCID: PMC6005105 DOI: 10.1093/heapol/czy045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6-48 months for 6 months in 2015. The SC and FFV interventions provided $14 monthly and the DC provided $28 monthly. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted. Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at $4865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was $1290 for DC, $882 for SC and $883 for FFV. The cost per DALY averted was $641 for DC, $434 for SC and $563 for FFV without discounting or age weighting. These interventions are highly cost-effective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, these findings may provide justification for continuing Pakistan's investment in national social safety nets.
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Affiliation(s)
- Lani Trenouth
- Action Against Hunger, 1 Whitehall St, New York, NY 10004, USA
| | - Timothy Colbourn
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Bridget Fenn
- Emergency Nutrition Network, 32 Leopold Street, Oxford OX4 1TW, UK
| | - Silke Pietzsch
- Action Against Hunger, 1 Whitehall St, New York, NY 10004, USA
| | - Mark Myatt
- Brixton Health, Alltgoch Uchaf Llawryglyn, Caersws, Powys SY17 5RJ, UK
| | - Chloe Puett
- Action Against Hunger, 1 Whitehall St, New York, NY 10004, USA
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Verheijen J. The gendered micropolitics of hiding and disclosing: assessing the spread and stagnation of information on two new EMTCT policies in a Malawian village. Health Policy Plan 2018; 32:1309-1315. [PMID: 28981664 DOI: 10.1093/heapol/czx088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/13/2022] Open
Abstract
Analysing why certain information spreads-or not-can be highly relevant for understanding an intervention's potential impact. Two recently implemented policy changes related to EMTCT (elimination of mother-to-child transmission of HIV) in the Balaka district of Malawi give ample opportunity to assess how new information trickles through a targeted rural community. One of the policies entails the lifetime provision of ART (anti-retroviral therapy) to all HIV+ pregnant women-a governmental strategy to EMTCT first initiated in Malawi and now being expanded throughout the region. The second new policy concerns a pilot project in which women are financially rewarded for attending antenatal care and delivering in the hospital. An in-depth anthropological approach was used to assess what women in one village community know about the policy changes and how they had come to know about it. Although the policies were implemented more or less at the same time, awareness and knowledge levels among village women differed largely: In case of the first, awareness stagnated at the level of those who directly received the information from health professionals. In the case of the second, highly accurate and up-to-date knowledge had spread throughout the village community. I suggest three reasons for this divergence: (i) perceived talk-worthiness of (issues addressed by) the interventions, (ii) motives for hiding or disclosing involvement in either of the interventions and (iii) the visibility of each intervention, or in other words, the (im)possibility to hide involvement. I argue that these reasons for women's structural silence on one policy change and prompt sharing of information on another follow a distinctly gendered logic. The findings underline that the diffusion of new information is to a great extent shaped by the social particularities of the context in which it is introduced.
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Affiliation(s)
- Janneke Verheijen
- Department of Cultural Anthropology and Development Sociology, Universiteit Leiden, Koopweg 65, 1402PC Bussum, The Netherlands
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Peterman A, Palermo TM, Handa S, Seidenfeld D. List randomization for soliciting experience of intimate partner violence: Application to the evaluation of Zambia's unconditional child grant program. Health Econ 2018; 27:622-628. [PMID: 28880429 PMCID: PMC6662601 DOI: 10.1002/hec.3588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 06/07/2023]
Abstract
Social scientists have increasingly invested in understanding how to improve data quality and measurement of sensitive topics in household surveys. We utilize the technique of list randomization to collect measures of physical intimate partner violence in an experimental impact evaluation of the Government of Zambia's Child Grant Program. The Child Grant Program is an unconditional cash transfer, which targeted female caregivers of children under the age of 5 in rural areas to receive the equivalent of US $24 as a bimonthly stipend. The implementation results show that the list randomization methodology functioned as planned, with approximately 15% of the sample identifying 12-month prevalence of physical intimate partner violence. According to this measure, after 4 years, the program had no measurable effect on partner violence. List randomization is a promising approach to incorporate sensitive measures into multitopic evaluations; however, more research is needed to improve upon methodology for application to measurement of violence.
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Affiliation(s)
| | - Tia M Palermo
- UNICEF Office of Research-Innocenti, Florence, Italy
| | - Sudhanshu Handa
- University of North Carolina at Chapel Hill, Department of Public Policy, Chapel Hill, NC, USA
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Prudhon C, Benelli P, Maclaine A, Harrigan P, Frize J. Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries. Matern Child Nutr 2018; 14:e12457. [PMID: 28670790 PMCID: PMC6865874 DOI: 10.1111/mcn.12457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 01/08/2023]
Abstract
Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.
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Abstract
We study the impact of the Zimbabwe Harmonized Social Cash Transfer (HSCT) on household food security after 12 months of implementation. We investigate determinants of food security as measured by a well-known food security scale - the Household Food Insecurity Access Scale (HFIAS) - and as measured by value of household food consumption composed of own-production, market purchases and gifts received. We find that several dimensions of household vulnerability correlate more strongly with the food security measure than with food consumption. Labor constraints, which is a key vulnerability criterion used by the HSCT to target households, is an important predictor of the food security score but not food consumption, and its effect on food security is even larger during the lean season. Impact analysis shows that the program has had statistically significant impacts on Food Security and Diet Diversity scores but null to low impacts on food consumption. However aggregate food consumption hides dynamic activity taking place within the household where the cash is used to obtain more food from the market and rely less on food received as gifts. The cash in turn gives beneficiaries greater choice in their food basket, which improves diet diversity.
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Affiliation(s)
- Garima Bhalla
- Department of Public Policy, Abernethy Hall, CB# 3435, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3435, USA
| | - Sudhanshu Handa
- Department of Public Policy, Abernethy Hall, CB# 3435, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3435, USA
| | - Gustavo Angeles
- Department of Maternal & Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7445, USA
| | - David Seidenfeld
- American Institutes for Research, 1000 Thomas Jefferson St NW #200, Washington, DC 20007, USA
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Lawlor K, Handa S, Seidenfeld D. CASH TRANSFERS ENABLE HOUSEHOLDS TO COPE WITH AGRICULTURAL PRODUCTION AND PRICE SHOCKS: EVIDENCE FROM ZAMBIA. J Dev Stud 2017; 55:209-226. [PMID: 31213728 PMCID: PMC6581456 DOI: 10.1080/00220388.2017.1393519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/25/2017] [Indexed: 06/09/2023]
Abstract
Climate change is projected to dramatically disrupt rainfall patterns and agricultural yields in Sub-Saharan Africa. These shocks to food production can mire farming households in poverty traps. This study investigates whether unconditional cash transfers can help households cope with agricultural production and price shocks. We find that cash empowers poor, rural households facing these negative shocks to employ coping strategies typically used by the non-poor and enables them to substantially increase their food consumption and overall food security. Extending relatively small cash payments unconditionally to the rural poor is a powerful policy option for fostering climate-resilient development.
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Affiliation(s)
- Kathleen Lawlor
- Department of Economics, University of North Carolina at Asheville, Asheville, NC, USA
| | - Sudhanshu Handa
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Child Poverty and Social and Economic Policy Responses, UNICEF Office of Research, Florence, Italy
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Pace N, Daidone S, Davis B, Handa S, Knowles M, Pickmans R. One plus one can be greater than two: Evaluating synergies of development programmes in Malawi. J Dev Stud 2017; 54:2023-2060. [PMID: 31462824 PMCID: PMC6713287 DOI: 10.1080/00220388.2017.1380794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/25/2017] [Indexed: 06/10/2023]
Abstract
This paper investigates the interplay between the Social Cash Transfer Programme (SCTP) and the Farm Input Subsidy Programme (FISP) in Malawi. We take advantage of data collected from a seventeen-month evaluation of a sample of households eligible to receive SCTP, which also provided information about inclusion into FISP. We estimate two types of synergies: i) the complementarity between SCTP and FISP, i.e. whether the impact of both interventions run together is larger than the sum of the impacts of these interventions when run separately, and ii) the incremental impact of receiving FISP when a household already receives SCTP, as well as the incremental impact of receiving SCTP when a household already receives FISP. The analysis shows that there are synergies between the two policy interventions, mainly in terms of incremental impact of each programme over the other, in increasing expenditure, agricultural production and livestock.
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Affiliation(s)
- Noemi Pace
- Corresponding author: Noemi Pace, Food and Agriculture Organization (FAO) of the United Nations and University Ca’ Foscari of Venice.,
| | - Silvio Daidone
- Social Policies and Rural Institutions Division (ESP), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Benjamin Davis
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Sudhanshu Handa
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Knowles
- Social Policies and Rural Institutions Division (ESP), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Robert Pickmans
- Department of Agricultural and Resource Economics, University of Berkeley, Berkeley, CA, USA
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Kilburn K, Handa S, Angeles G, Mvula P, Tsoka M. Short-term Impacts of an Unconditional Cash Transfer Program on Child Schooling: Experimental Evidence from Malawi. Econ Educ Rev 2017. [PMID: 29531427 PMCID: PMC5844286 DOI: 10.1016/j.econedurev.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This study analyzes the impact of a positive income shock on child schooling outcomes using experimental data from an unconditional cash transfer program in Malawi. Since households receive the cash and parents are responsible for making spending decisions, we also examine the intervening pathways between cash transfers and child schooling. Data comes from a cluster-randomized study of Malawi's Social Cash Transfer Program (SCTP). After a baseline survey, households in village clusters were randomly assigned to treatment and control arms with treatment villages receiving transfers immediately and control villages assigned a later entry. We test for treatment impacts on a panel of school-aged children (6-17) using a differences-in-differences model. After a years' worth of transfers, we find the Malawi SCTP both improves enrollment rates and decreases dropouts. The main intervening pathway between the program and schooling is education expenditures, suggesting that the cash improves the demand for education by reducing financial constraints.
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Affiliation(s)
- Kelly Kilburn
- Department of Public Policy, University of North Carolina-Chapel Hill
- Kelly Kilburn is the corresponding author,
| | - Sudhanshu Handa
- Department of Public Policy, University of North Carolina-Chapel Hill
| | - Gustavo Angeles
- Department of Maternal and Child Health, University of North Carolina-Chapel Hill
| | - Peter Mvula
- Centre for Social Research, University of Malawi
| | - Maxton Tsoka
- Centre for Social Research, University of Malawi
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Bonilla J, Zarzur RC, Handa S, Nowlin C, Peterman A, Ring H, Seidenfeld D. Cash for Women's Empowerment? A Mixed-Methods Evaluation of the Government of Zambia's Child Grant Program. World Dev 2017; 95:55-72. [PMID: 31363300 PMCID: PMC6667169 DOI: 10.1016/j.worlddev.2017.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
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-randomized 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 methodological 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.
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Abstract
Childhood malnutrition remains a significant global problem, with an estimated 162 million children under the age of five suffering from stunted growth. This article examines the extent to which cash transfer programmes can improve child nutrition. It adopts a framework that captures and explains the pathways and determinants of child nutrition. The framework is then used to organize and discuss relevant evidence from the impact evaluation literature, focusing on impact pathways and new and emerging findings from sub-Saharan Africa to identify critical elements that determine child nutrition outcomes as well as knowledge gaps requiring further research, such as children's dietary diversity, caregiver behaviours and stress.
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Affiliation(s)
- Richard de Groot
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Tia Palermo
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Sudhanshu Handa
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
- department of Public Policy, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | - Amber Peterman
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
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Czaicki NL, Mnyippembe A, Blodgett M, Njau P, McCoy SI. It helps me live, sends my children to school, and feeds me: a qualitative study of how food and cash incentives may improve adherence to treatment and care among adults living with HIV in Tanzania. AIDS Care 2017; 29:876-884. [PMID: 28397527 DOI: 10.1080/09540121.2017.1287340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Financial and in-kind incentives have been shown to improve outcomes along the HIV care cascade, however the potential mechanismsthrough which they work remain unclear. To identify the pathways through which incentives improve retention in care and adherence to antiretroviral therapy (ART), we conducted a qualitative study with participants in a trial evaluating conditional food and cash incentives for HIV-positive food insecure adults in Shinyanga, Tanzania. We found that the incentives acted through three pathways to potentially increase retention in care and adherence to ART: (1) addressing competing needs and offsetting opportunity costs associated with clinic attendance, (2) alleviating stress associated with attending clinic and meeting basic needs, and (3) by potentially increasing motivation. Participants did not report any harmful events associated with the incentives, but reported myriad beneficial effects on household welfare. Understanding how incentives are used and how they impact outcomes can improve the design of future interventions.
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Affiliation(s)
- Nancy L Czaicki
- a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA
| | - Agatha Mnyippembe
- b Regional Medical Office, Ministry of Health, Community Development, Gender, Elderly, and Children , Shinyanga , Tanzania
| | - Madeline Blodgett
- a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA.,c The Sea Change Program , Berkeley , CA , USA
| | - Prosper Njau
- d Prevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children , Dar es Salaam , Tanzania
| | - Sandra I McCoy
- a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA
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Handa S, Peterman A, Seidenfeld D, Tembo G. Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. Health Econ 2016; 25:225-36. [PMID: 25581062 PMCID: PMC5488682 DOI: 10.1002/hec.3136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 11/04/2014] [Accepted: 11/12/2014] [Indexed: 05/22/2023]
Abstract
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 randomized 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 settings to impact maternal health.
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Affiliation(s)
- Sudhanshu Handa
- Department of Public Policy, University of North Carolina, Chapel Hill, NC, USA
- Child Poverty and Social and Economic Policy Responses, UNICEF Office of Research, Florence, Italy
| | - Amber Peterman
- Department of Public Policy, University of North Carolina, Chapel Hill, NC, USA
| | | | - Gelson Tembo
- Department of Agricultural Economics, University of Zambia, Lusaka, Zambia
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Green EP, Blattman C, Jamison J, Annan J. Does poverty alleviation decrease depression symptoms in post-conflict settings? A cluster-randomized trial of microenterprise assistance in Northern Uganda. Glob Ment Health (Camb) 2016; 3:e7. [PMID: 28596876 DOI: 10.1017/gmh.2015.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished. METHODS This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120 villages in Northern Uganda were invited to participate. Community committees were asked to identify the most vulnerable women (and some men) to participate. The implementing agency screened all proposed participants, and a total of 1800 were enrolled. Following a baseline survey, villages were randomized to a treatment or wait-list control group. Participants in treatment villages received training, start-up capital, and follow-up support. Participants, implementers, and data collectors were not blinded to treatment status. RESULTS Villages were randomized to the treatment group (60 villages with 896 participants) or the wait-list control group (60 villages with 904 participants) with an allocation ration of 1:1. All clusters participated in the intervention and were included in the analysis. The intent-to-treat analysis included 860 treatment participants and 866 control participants (4.1% attrition). Sixteen months after the program, monthly cash earnings doubled from UGX 22 523 to 51 124, non-household and non-farm businesses doubled, and cash savings roughly quadrupled. There was no measurable effect on a locally derived measure of symptoms of depression. CONCLUSIONS Despite finding large increases in business, income, and savings among the treatment group, we do not find support for an indirect effect of poverty alleviation on symptoms of depression.
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Chaturvedi S, De Costa A, Raven J. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh. Glob Health Action 2015; 8:27427. [PMID: 26160769 PMCID: PMC4497976 DOI: 10.3402/gha.v8.27427] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/12/2015] [Accepted: 06/14/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. DESIGN 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. RESULTS Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. CONCLUSIONS Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes.
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Affiliation(s)
- Sarika Chaturvedi
- Department of Public Health and Environment, R D Gardi Medical College, Ujjain, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
| | - Ayesha De Costa
- Department of Public Health and Environment, R D Gardi Medical College, Ujjain, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Abstract
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.
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Affiliation(s)
- John Fieno
- a Regional HIV/AIDS Program, US Agency for International Development , Pretoria , South Africa
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