Cash transfer schemes and the health sector: making the case for greater involvement.

Perspectives Cash transfer schemes can be important contributors to human development and social protection. Although they have significant health benefits, they have rarely been considered an integral part of the health policy portfolio. We believe that a case can be made for greater health sector involvement in the design, implementation and evaluation of such schemes. Cash transfers (CTs) are attracting increasing interest as effective and acceptable means of improving the welfare of disadvantaged households in low-and middle-income countries. They give households regular, predictable amounts of money in the form of pensions, child benefits or regular household grants. Although such social protection mechanisms are often the norm in high-income countries, CTs have historically been rare in low-and middle-income countries. Instead, governments and donors have typically preferred supply-side interventions (expanding health care coverage, for example) or in-kind transfers of goods or food. Financial shocks during the late 1990s, however, triggered a global shift towards social protection schemes more closely resembling European models (emphasizing social security rather than assistance as a last resort). This shift also reflected a desire to correct shortcomings associated with reforms advocated under the Washington consensus, characterized by the dismantling of State services and their replacement with segmented private services. CTs can contribute to economic and social development, particularly pro-poor development, for several reasons. Lack of resources makes poor households risk-averse, and they therefore seek to minimize their exposure to environmental , economic and social risks. As a result, however, they may also pass up more profitable opportunities. Planting reliable but low-yield crops is an example. Economic shocks force impoverished families to make decisions that satisfy immediate survival needs at the expense of future income, such as selling livestock or withdrawing children from school, which may irreversibly weaken the household. Relieving poverty can enable such households to manage risk and respond to shocks more effectively. СTs can also promote positive social norms. Transfers to women enhance their status and increase their participation in household decision-making. They also increase the likelihood that household income will be spent on children's schooling and on nutritious food. Transfers can contribute to social cohesion and citizenship, as well, if implemented alongside other elements of social protection. In addition, transfers can develop individuals' capabilities and potential by encouraging them to avail themselves of health, education and other public services, either through social marketing or through the establishment of conditions that CT beneficiaries must fulfil – …