Article Text

Impact of conditional and unconditional cash transfers on health outcomes and use of health services in humanitarian settings: a mixed-methods systematic review
  1. Kim Robin van Daalen1,
  2. Sara Dada2,
  3. Rosemary James3,
  4. Henry Charles Ashworth4,
  5. Parnian Khorsand5,
  6. Jiewon Lim6,
  7. Ciaran Mooney7,
  8. Yasmeen Khankan8,
  9. Mohammad Yasir Essar9,
  10. Isla Kuhn10,
  11. Helene Juillard11,
  12. Karl Blanchet12
  1. 1Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, Cambridge University, Cambridge, UK
  2. 2UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
  3. 3University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Stoke-on-Trent, UK
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Women in Global Health, Washington, District of Columbia, USA
  6. 6School of Medicine, NUI Galway, Galway, Ireland
  7. 7Northern Ireland Medical and Dental Training Agency, Belfast, Antrim, UK
  8. 8Department of Biology, Siena Heights University, Adrian, Michigan, USA
  9. 9Kabul University of Medical Sciences, Kabul, Afghanistan
  10. 10Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
  11. 11Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Geneva, Switzerland
  12. 12Global Health Development, University of Geneva Faculty of Medicine, Geneve, Switzerland
  1. Correspondence to Ms Kim Robin van Daalen; krv22{at}


Background Cash transfers, payments provided by formal or informal institutions to recipients, are increasingly used in emergencies. While increasing autonomy and being supportive of local economies, cash transfers are a cost-effective method in some settings to cover basic needs and extend benefits of limited humanitarian aid budgets. Yet, the extent to which cash transfers impact health in humanitarian settings remains largely unexplored. This systematic review evaluates the evidence on the effect of cash transfers on health outcomes and health service utilisation in humanitarian contexts.

Methods Studies eligible for inclusion were peer reviewed (quantitative,qualitative and mixed-methods). Nine databases (PubMed, EMBAS, Medline, CINAHL, Global Health, Scopus, Web of Science Core Collection, SciELO and LiLACS) were searched without language and without a lower bound time restriction through 24 February 2021. The search was updated to include articles published through 8 December 2021. Data were extracted using a piloted extraction tool and quality was assessed using The Joanna Briggs Critical Appraisal Tool. Due to heterogeneity in study designs and outcomes, results were synthesised narratively and no meta-analysis was performed.

Results 30 673 records were identified. After removing duplicates, 17 715 were double screened by abstract and title, and 201 in full text. Twenty-three articles from 16 countries were included reporting on nutrition outcomes, psychosocial and mental health, general/subjective health and well-being, acute illness (eg, diarrhoea, respiratory infection), diabetes control (eg, blood glucose self-monitoring, haemoglobin A1C levels) and gender-based violence. Nineteen studies reported some positive impacts on various health outcomes and use of health services, 11 reported no statistically significant impact on outcomes assessed and 4 reported potential negative impacts on health outcomes.

Discussion Although there is evidence to suggest a positive relationship between cash transfers and health outcomes in humanitarian settings, high-quality empirical evidence, that is methodologically robust, investigates a range of humanitarian settings and is conducted over longer time periods is needed. This should consider factors influencing programme implementation and the differential impact of cash transfers designed to improve health versus multipurpose cash transfers.

PROSPERO registration number CRD42021237275.

  • child health
  • mental health & psychiatry
  • nutrition
  • public health
  • systematic review

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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  • Handling editor Seye Abimbola

  • Twitter @daalenkim, @dadasara3, @rosiejames96, @HenryCAshworth, @ciaranmmooney, @EssarYasir, @ilk21, @BlanchetKarl

  • Contributors KRvD conceived the presented idea and developed the research protocol with support from SD, RJ, HCA, PK, JL, CM, YK, MYE and IK. KRvD, SD, RJ, HCA, PK, JL, CM, YK, MYE and IK collected, analysed, and synthesised the data. KB and HJ provided critical feedback and expertise on the protocol, analysis and write-up. All authors have made substantial, direct and intellectual contributions to the work and approved it for publication. KRvD is responsible for the overall content.

  • Funding This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. KRvD received funding from the Gates Cambridge Trust (OP114) for her PhD studies and received funding for publication of this article from the Gates Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.