Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications

Abstract

OBJECTIVE To quantify the impact of cash transfer and microfinance interventions on a selected list of tuberculosis (TB) risk factors and assess their potential role in supporting TB control. DATA SOURCE Published and unpublished references identified from clinical and social electronic databases, grey literature and web sites. METHODS Eligible interventions had to be conducted in middle- or low-income countries and document an impact evaluation on any of the following outcomes: 1) TB or other respiratory infections; 2) household socio-economic position; and 3) factors mediating the association between low household socio-economic position and TB, including inadequate health-seeking behaviours, food insecurity and biological TB risk factors such as human immunodeficiency virus (HIV) and adult malnutrition. Interventions targeting special populations were excluded. RESULTS Fifteen cash transfer schemes (four unconditional and 11 conditional) and seven microfinance programmes met the eligibility criteria. No intervention addressed TB or any other respiratory infection. Of 11 cash transfer and four microfinance interventions, respectively seven and four reported a positive impact on indicators of economic well-being. A positive impact on household food security was documented in respectively eight of nine and three of five cash transfer and microfinance interventions. Improved health care access was documented respectively in 10 of 12 cash transfer and four of five microfinance interventions. The only intervention evaluating impact on HIV incidence was a microfinance project that found no effect. No cash transfer or microfinance interventions had an impact on adult malnutrition. CONCLUSIONS Cash transfer and microfinance interventions can positively impact TB risk factors. Evaluation studies are urgently needed to assess the impact of these social protection interventions on actual TB indicators.

Barriers to Utilization of HIV Care Services Among Adolescents and Young Adults in Rakai, Uganda: the Role of Economic Strengthening

“…Although information on impact of economic strengthening on uptake of HIV care services is lacking, improved uptake of HIV screening and treatment and improved treatment outcomes have been reported in some social protection interventions, such as cash transfers (Boccia et al 2011). In Uganda, studies on economic empowerment for adolescents showed that Basset building^reduced poverty, improved psychosocial functioning, and positively impacted attitudes and behaviors (Ssewamala et al 2008).…”

Is There a Need to Mitigate the Social and Financial Consequences of Tuberculosis at the Individual and Household Level?

“…A positive impact on household food security was documented in respectively eight of nine and three of five cash transfer and microfinance interventions. Improved health care access was documented respectively in 10 of 12 cash transfer and four of five microfinance interventions [43]. No study, however, analysed the cost effectiveness in detail.…”

Beyond pills and tests: addressing the social determinants of tuberculosis

“…61 However, there was little operational evidence to guide implementation or evaluate the impact of TBrelated socio-economic support, including cash transfer interventions. 9,15,17,18 , 54-56 , 62-68 Building on the lessons learnt during the ISIAT project, 15 extensive expert and TB civil society consultation, 54 a systematic review of cash transfer interventions 55 and the phase 1 published research, 11 our IFHAD research group was funded by the Joint Global Health Trials (a consortium of Wellcome Trust, Medical Research Council and the UK Department for International Development) to undertake the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) project. The conception, design, and implementation of the complex TB-specific socio-economic intervention is described in more detail elsewhere.…”