From Vox
No questions this time, but I'm keen to hear your opinions about this approach, and if/how it should apply in health research.
That's a fascinating article. I'm impressed that USAID is prepared to evaluate its interventions (which presumably they have been developing over decades) to assess whether they are any more effective than just giving people the cash.
I'm sure there must be health contexts where this approach would be useful. Are there areas of health (obesity? mental health?) where in theory receiving a cash grant could help people to improve their own outcomes - and this might be more effective than taking part in a specially designed programme? What about communities that have longstanding experience of a particular disease or condition that might be able to design their own solutions, given the right resources?
It makes me think of Personal Health Budgets: https://www.peoplehub.org.uk/. Or am I digressing?!
I'm sure there must be health contexts where this approach would be useful. Are there areas of health (obesity? mental health?) where in theory receiving a cash grant could help people to improve their own outcomes - and this might be more effective than taking part in a specially designed programme? What about communities that have longstanding experience of a particular disease or condition that might be able to design their own solutions, given the right resources?
It makes me think of Personal Health Budgets: https://www.peoplehub.org.uk/. Or am I digressing?!
Hi Catherine - Not a digression at all! I know there is some movement in this direction in the mental health field, where affected persons are engaged to define (and deliver) interventions and consulted about outcome metrics which are meaningful to them.
Thanks for sharing the link. There must be an MSc project here for the making...
Thanks for sharing the link. There must be an MSc project here for the making...
Unconditional cash transfers have long been studied for health outcomes, and especially in the health sector from both a health outcomes / impact perspective and the cost of delivering the packages (eg. cash versus food delivery). The advancements in the humanitarian sector and HIV/TB are quite advanced in studying the impacts which is why there is now a whole sector working to transition in the humanitarian and the health sector to unconditional cash transfers. WFP and UNHCR take the lead in the humanitarian sector in this area, and have innovative means of delivering the cash as well - including the use of blockchain technologies. It links into the discussions and debates around universal incomes, pilots that have taken place globally with similar impacts of advancing certain populations out of welfare situations. It will be interesting to see more of these studies continue to take place, and certainly in the current economic climate with COVID-19 related pressures on the health of the economy and employment rates.
On another note, glad to see this movement towards value for money evaluations of interventions taking place. USAID has increasingly been developing robust requirements around the M&E of their investments, especially in pilot projects. Case in point here. The evidence here I am sure will continue to impact the future of other programs they and other bi and multilaterals finance in the future as greater evidence gathers.
On another note, glad to see this movement towards value for money evaluations of interventions taking place. USAID has increasingly been developing robust requirements around the M&E of their investments, especially in pilot projects. Case in point here. The evidence here I am sure will continue to impact the future of other programs they and other bi and multilaterals finance in the future as greater evidence gathers.
This is so interesting, thank you Sarah. It's prompted me to do a bit of background reading - here is a 2017 Cochrane Review of the effect of unconditional cash transfers on health outcomes: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011135.pub2/full
I find this subject fascinating. Let me know if there is other reading material that you would recommend!
I find this subject fascinating. Let me know if there is other reading material that you would recommend!
Catherine, thanks for sharing the Cochrane Review, I'll have a look. I thought you might be interested in this cash transfer programme some colleagues of mine worked on in Zimbabwe - https://insights.careinternational.org.uk/media/k2/attachments/CARE_CTP-lessons-from-Zimbabwe-summary_2017_web.pdf
What an impressive and worthwhile project Katherine. Thanks for sharing, Judith
Thanks for sharing this Catherine. I would also be interested in hearing more. Judith
That's very interesting Sarah, thank you. Judith
Hi everybody...
A very interesting article indeed. Thank you everybody for your insightful posts.
I am thinking about the validity of the results presented in this particular article. The intervention here is a job-training intervention- by all means, I think it would affect the individual in the long term. This is why I feel what has been presented here seems too premature. Providing money in the short term definitely might appear to fare better in terms of the outcomes they are looking at- but what about the time period after the end of such an intervention? I am sure the cash benefit is not intended to be lifelong right? the educational intervention would be expected to last lifelong... It will be really interesting to see the long term benefits- I think they will be looking at the 3 year mark...
I can see how giving cash instead of short term interventions might prove to be better. It's understandable that people would have solutions to their immediate problems if they are just given the money. However, its hard for me to see the benefits of unconditional cash when compared to interventions that change lifestyles or are educational or training based. Its good to look at how interventions are faring when compared to cash only but these studies need to well designed and interpreted accordingly. I am scared that we could get into the habit of handing out money instead of working to improve interventions to do better than money...
Fathima
A very interesting article indeed. Thank you everybody for your insightful posts.
I am thinking about the validity of the results presented in this particular article. The intervention here is a job-training intervention- by all means, I think it would affect the individual in the long term. This is why I feel what has been presented here seems too premature. Providing money in the short term definitely might appear to fare better in terms of the outcomes they are looking at- but what about the time period after the end of such an intervention? I am sure the cash benefit is not intended to be lifelong right? the educational intervention would be expected to last lifelong... It will be really interesting to see the long term benefits- I think they will be looking at the 3 year mark...
I can see how giving cash instead of short term interventions might prove to be better. It's understandable that people would have solutions to their immediate problems if they are just given the money. However, its hard for me to see the benefits of unconditional cash when compared to interventions that change lifestyles or are educational or training based. Its good to look at how interventions are faring when compared to cash only but these studies need to well designed and interpreted accordingly. I am scared that we could get into the habit of handing out money instead of working to improve interventions to do better than money...
Fathima
Hi all
Some thoughts, more from low income setting perspective as this is what the article focused on.
Some thoughts, more from low income setting perspective as this is what the article focused on.
to evaluate efficacy of cash transfers over another health intervention, an RCT would be needed, I think.
If one were to add cash transfer in the control arm of such RCT, participants in resource-limited settings could be more motivated to take part in the control arm, and this may hinder trial recruitment .
(this would not necessarily be the case in high income settings)
If one were to add cash transfer in the control arm of such RCT, participants in resource-limited settings could be more motivated to take part in the control arm, and this may hinder trial recruitment .
(this would not necessarily be the case in high income settings)
also, health interventions are often about embedding these into health systems if successful. can individual cash allocations contribute to effective health seeking in the absence of an appropriate underlying healthcare system and in settings where individuals may be driven to allocate this cash to other expenses?
Of course a lot depends on the study population, the setting, and the outcome being addressed. for instance in the HealthBudget programme, I can see how direct cash transfer can work for people who need long-term care and wish to organise it in an empowered manner according to the endpoints meaningful to them. It could also potentially work to modify the type of food consumed as a risk factor for NCDs assuming healthier food is more expensive, but here I think that a behavioural intervention in addition to cash would still be needed..
Best wishes
Olga