Background
Understanding social protection and its linkages to health
Aims
Methods
Overview of reviews
Search strategy
Study selection & criteria
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Published in English, Spanish, or Portuguese
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Both peer-reviewed and grey literature
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Includes at least one of the following: conditional/non-conditional transfers, social grants, non-monetary grants (such as food assistance), protective labor regulations, and includes programs delivered by sub-national or national level governments, rather than smaller scale, NGO run initiatives. Government run food assistance programs may encompass food stamps, food subsidies, women, infants and children feeding programs, and food price stabilization.
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Assesses one of the following: health impact, access to health services, effects on the health system, or the linkage between social protection and health systems
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Includes articles based on LMIC experience.
Data extraction
Quality assessment and data synthesis
Policy-maker interviews
WHO Region | Countries Included | Total No. Respondents Identified & Invited | Total No. Respondents Included | Total No. Respondents Discussing Social Protection | Interview Language(s) |
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Africa Region | Ghana, Kenya, Liberia, South Africa, Uganda, Zimbabwe | 30 | 12 | 8 | English |
Region of the Americas: | Argentina, Caribbean Region (23 member states) | 14 | 10 | 9 | English, Spanish |
South-East Asia Region: | Bhutan, India, Indonesia, Myanmar, Thailand | 18 | 14 | 10 | English |
European Region | 0 | 0 | 0 | NA | |
Eastern Mediterranean Region | Bahrain, Jordan, Pakistan, Somalia, Tunisia | 5 | 4 | 4 | English, Arabic, French |
Western Pacific Region | China, Kiribati, Laos, Philippines, Vanuatu | 15 | 8 | 8 | English, Mandarin |
Multi/Bi-lateral Org/NGOs | NA | 7 | 6 | 5 | English |
Focus Group Country | No. of Respondents Invited | Total No. Respondents Included | Focus Group Discussion Language |
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Bahrain | 16 | 10 | English |
Jordan | 17 | 17 | Arabic |
Identification of research questions
Consultation with researchers: Refining and ranking of research questions
Results
Overview of reviews
Categories of social protection interventions
Intervention | Review Papers |
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Cash Transfers (Conditional & Unconditional) | |
Other Financial Incentives/Demand Side Financing Interventions | |
Food Aid and Nutritional Interventions | |
Parental Leave | [25] |
Livelihood or Other Types of Social Welfare |
Questions for future research identified in review papers
Policy-maker interviews
Questions for future research identified from policy-maker consultations
Priority research questions
Final research questions & ranking
Global Theme | Research Need | Finalized Research Quesiton |
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Evidence of Effectiveness | Increase overall evidence base for demand side interventions on impact | What are the effects of conditional cash transfer programs on healthcare quality, coverage and outcomes across settings in low and middle income countries? |
What are the effects of unconditional cash transfer programs on healthcare quality, coverage and outcomes across settings in low and middle income countries? | ||
How do the characteristics of cash transfers such as the amount, frequency, method of payment, etc., affect intended outcomes, particularly enrollment of the target population? | ||
What are the impacts of social protection programs in conflict affected settings and their effectiveness in improving health outcomes and access to health services? | ||
Longevity of effects | What are the long-term effects of cash transfer programs or social protection programs on behavior change, and how sustainable have they been? | |
How can demand-side financing for health be made financially sustain able? | ||
How can social protection programs for health be designed, implemented, and evaluated to ensure sustainability and scalability in low and middle income countries, including conflict affected settings? | ||
Increase understanding of the equity effects of CCTs/demand side financing | What is the impact of social protection initiatives on health equity outcomes and equitable access to quality health care services for poor and marginalized populations? | |
Evidence of Effectiveness for Specific Services | Increasing evidence around the way food aid is delivered and its effect on intended outcomes | How do the characteristics of food aid programs (e.g. source, amount, frequency, mode, recipient etc.) affect intended health-related outcomes (e.g. morbidity, sustained behavior changes, drug adherence, labor market participation etc.)? |
Increasing evidence for paid maternity leave and the link to health outcomes | What are the impacts of different forms of maternity leave (paid vs. unpaid, length, etc.) on maternal and child health outcomes? | |
Evidence of Effectiveness for Cost Effectiveness | Increasing evidence of DSF on OOP | How do demand-side financing or CCT programs affect out-of-pocket spending on health? |
Increasing evidence on cost-effectiveness and efficiency | How cost-effective are CCT programs compared to supply-side interventions (e.g. strengthening quality of infrastructure and expanding services) in improving health? | |
How cost-effective are CCT programs compared with other types of demand side interventions (e.g. UCTs, vouchers, behavior change, communication) in improving health coverage and health outcomes? | ||
Pathways of impact/methods | Strengthen our understanding in the ways that internal and external factors influence SP programs and their effectiveness | What are the pathways through which social protection programs affect clinical and nonclinical outcomes, and what are the implications on program design? |
What are the contextual factors that influence the effectiveness of conditional and unconditional cash transfer schemes for health? | ||
Strengthen our understanding in the ways that SP programs affect intergenerational relationships | How do social protection programs (e.g. cash transfers) affect intergenerational and gender relationships at the community and household level? | |
How do social protection programs for health affect intergenerational poverty and social mobility? | ||
Strengthen our understanding of the importance of conditionality for cash transfer programs | How does conditionality in cash transfer programs affect behavioral changes for disease prevention and treatment? | |
Unintended Consequences | Strengthen our understanding of the unintended consequences of social protection programs | What are the unintended health-related consequences of social protection programs? |
How can social protection programs be designed to minimize dependency and promote productivity amongst beneficiaries? | ||
What is the extent of fraud and abuse in health-related social protection programs, and how can social protection programs be designed to show accountability? | ||
Program Implementation | Identify tools to help with determining eligibility for SP interventions. | What tools and systems can be used to assess and apply eligibility criteria for health-related social protection programs? |
Strengthen our understanding on how SP programs should best integrate or interact with specific groups of people or other sectors | How can the community/civil society be engaged to help design, implement and evaluate social protection programs? | |
How can various social protection initiatives be best integrated or harmonized across sectors? | ||
How do social protection programs influence the interaction between public and private health care providers with regards to service availability, quality of care and utilization? | ||
How do we provide social protection programs to refugee populations without undermining support for nationals? | ||
How can informal sector and migrant workers be effectively covered by health-related social protection systems? | ||
How can social protection schemes help in ensuring that the most vulnerable such as the disabled are provided with people-centered and integrated services? | ||
How can social protection systems help in protecting people from domestic violence and its consequences? | ||
Strengthen our understanding of linkages between SP for health and governance | How do social protection programs contribute to state building? | |
Data reliability and validity | Strengthen our understanding on how SP programs can be best monitored | How can routine information systems be strengthened and used to monitor and evaluate social protection systems for health? |
Rank | Question | Final Score (% of times question was preferred over the alternative) |
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1 | How can social protection programs for health be designed, implemented, and evaluated to ensure sustainability and scalability in low and middle-income countries, including conflict affected settings? (#6) | 80.5% |
2 | What are the contextual factors that influence the effectiveness of conditional and unconditional cash transfer schemes for health? (#29) | 71.1% |
3 | How can various social protection initiatives be best integrated or harmonized across sectors? (#21) | 66.7% |
4 | How cost-effective are CCT programs compared to supply-side interventions (e.g. strengthening quality of infrastructure and expanding services) in improving health? (#11) | 65.9% |
5 | What are the impacts of social protection programs in conflict affected settings and their effectiveness in improving health outcomes and access to health services? (#3) | 63.6% |
6 | What are the pathways through which social protection programs affect clinical and nonclinical outcomes, and what are the implications on program design? (#13) | 61.8% |
7 | What is the impact of social protection initiatives on health equity outcomes and equitable access to quality health care services for poor and marginalized populations? (#7) | 61.4% |
8 | How can routine information systems be strengthened and used to monitor and evaluate social protection systems for health? (#25) | 57.5% |
9 | How do social protection programs influence the interaction between public and private health care providers with regards to service availability, quality of care and utilization? (#22) | 55.6% |
10 | What are the effects of unconditional cash transfer programs on healthcare quality, coverage and outcomes across settings in low and middle-income countries? (#30) | 55.0% |
Rank | Most Cited: Scoping Review (count) | Rank | Most Cited: Policy-Maker Interviews (count) | Rank | Highest ranked (% votes) |
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1 | Q13: What are the pathways through which social protection programs affect clinical and nonclinical outcomes, and what are the implications on program design? [13] | 1 | Q25: How can routine information systems be strengthened and used to monitor and evaluate social protection systems for health? [13] | 1 | Q6: How can social protection programs for health be designed, implemented, and evaluated to ensure sustainability and scalability in low and middle-income countries, including conflict affected settings? (80.5%) |
2 | Q1: What are the effects of conditional cash transfer programs on healthcare quality, coverage and outcomes across settings in low and middle-income countries? [11] | 2 | Q21: How can various social protection initiatvies be best inegrated or harmonized across sectors? [12] | 2 | Q29: What are the contextual factors that influence the effectiveness of conditional and unconditional cash transfer schemes for health? (71.1%) |
3 | Q30: What are the effects of unconditional cash transfer programs on healthcare quality, coverage and outcomes across settings in low and middle-income countries? [9] | 3 | Q19: What tools and systems can be used to assess and apply eligibility criteria for health-related social protection programs? [8] | 3 | Q21: How can various social protection initiatives be best integrated or harmonized across sectors? (66.7%) |
3 | Q12: How cost-effective are CCT programs compared with other types of demand side interventions (e.g. UCTs, vouchers, behavior change, communication) in improving health coverage and health outcomes? [9] | 4 | Q18: What is the extent of fraud and abuse in health-related social protection programs, and how can social protection programs be designed to show accountability? [6] | 4 | Q11: How cost-effective are CCT programs compared to supply-side interventions (e.g. strengthening quality of infrastructure and expanding services) in improving health? (65.9%) |
4 | Q8: How do the characteristics of food aid programs (e.g. source, amount, frequency, mode, recipient etc.) affect intended health-related outcomes (e.g. morbidity, sustained behavior changes, drug adherence, labor market participation etc.)? [6] | 5 | Q4: What are the long-term effects of cash transfer programs or social protection programs on behavior change, and how sustainable have they been? [5] | 5 | Q3: What are the impacts of social protection programs in conflict affected settings and their effectiveness in improving health outcomes and access to health services? (63.6%) |
5 | Q26: How can informal sector and migrant workers be effectively covered by health-related social protection systems? [5] |