Our findings highlight the influence of the sociocultural context on the functioning and interaction between the individual, the family, and cash transfer programs. Recipients perceived the cash transfer as necessary and useful for immediate household needs in all types of cash transfer programs. To date, no audit has examined the design, delivery and outcomes of health-related cash transfer programs from the perspective of recipients, including their perceptions and experiences of cash transfers or the unintended consequences these interventions may have.
We first used a maximum variation sampling strategy (Ames 2019) to allow for a global perspective and understanding of the money transfer experience. One study did not present clear sampling criteria but included recipients of the money transfer program (Balen 2018). Our main concerns related to the methodological limitations of the studies and the adequacy of the data.
Our explanation of the GRADE-CERQual assessment for each assessment finding is presented in the evidence profiles table (Table 1). Details and explanation of the confidence assessment are presented in the table of evidence profiles (Table 1).
Perceptions of the cash transfer itself
In some studies, in addition to the recipient, the participants included program staff, health professionals, members of the recipient's family, or other non-recipient members of the community. In some of the included studies, insufficient attention was paid to the relationship between the researcher and the participants. All studies provided some, albeit very concise, description of context, participants, sampling strategy, methods and analysis.
Details of methodological limitations assessments for individual studies can be found in Table 2. Common methodological limitations included the lack of adequate consideration of the relationship between the researcher and. Furthermore, in some studies, the appropriateness of the recruitment strategy to the research aims was unclear.
In the themes described below, we have synthesized the perceptions and experiences of money transfer recipients regarding the use and role of the money transfer, the positive and negative effects of the money given its intended purpose, as well as unintended consequences of the money transfer, and the effects and outcomes of money within the household and community. Adolescents shared it with their parents, caregivers or siblings out of necessity, but also as a show of solidarity with the other family members.
Perceptions of the personal and social outcomes of the cash transfer
In some cases, for example in Canada (Struthers 2019) and Tanzania (Wamoyi 2020), the cash transfer was used for savings. Across all types of programs, the cash transfer enhanced the empowerment, autonomy, and/or agency of recipients. These recipients reported that the cash transfer gave them a sense of security, increased decision-making power in their households or with sex partners, and better social relationships as a result of the social capital building (Adato 2000a; Samuels 2016; Skovdal 2014).
Women, adolescents and people with disabilities felt that the cash gave them more autonomy (Garthwaite 2015; Thomson 2014), as it allowed them to become more independent from their partners or parents, and allowed them to contribute to the household and help ease their families' or carers' financial burden (Kelly 2019; Khoza 2018; Plagerson 2011; Struthers 2019; Ukwaja 2017). However, there was one exception where the cash transfer did not lead to women's empowerment (Gram 2019). In this study of an EC program in Nepal, women reported that the cash transfer was too low to increase their decision-making power in the household.
Social cohesion and the building of social capital were both direct and indirect effects of the money transfer. Stigma also led to low uptake of the cash transfer and people abandoned the process to claim the money (Holler 2020).
Perceptions of interaction with the cash transfer programme
Recipients reported waiting long hours to receive the cash transfer (Balen 2018; Yeboah 2016); going through various steps of document preparation and approval (Nirgude 2019);. In some cases of delay, the recipients did not receive the cash transfer at all (Yeboah 2016). Some recipients reported feeling like they were "customers" in the program or that the cash transfer was a favor (Owusu-Addo 2020).
This was due to personal circumstances or the participant's own perception of the cash transfer and the program. Our findings also suggest that women and men and different target groups may have different experiences of the cash transfer programs. Have you considered how the cash transfer will be used and shared in the household?
Programas de transferência condicionada de renda e acesso aos serviços de saúde: um estudo da experiência do Bolsa Família em Manguinhos, RJ [Dissertação de mestrado] em Manguinhos, RJ]. Os efeitos de uma intervenção de transferência de renda em parcerias sexuais e HIV no estudo HPTN 068 na África do Sul. Avaliação do Programa Bolsa-Alimentação/Programa de Transferência Condicionada de Renda: segunda fase.
IDI of the population sample of 10 people with TB, of which 7 people received the cash transfer and 3 did not. Population sample 20 longitudinal in-depth interviews (IDIs) and 60 cross-sectional IDIs with AGYW in the cash transfer program.
Search strategies Database search strategies
Advanced Search - Evidence Type (Primary Research; Practice-Based Information, Area of Interest (Public Health; Social Care; Clinical). Clara Akie Yoshino: Selecting Studies, Data Extraction, Analyzing Data, Writing and Editing Initial Draft. Kristi Sidney Annerstedt: Conceptualizing the Study , writing the protocol, selecting studies, evaluating studies for quality and richness, contributing to data analysis, writing and editing.
Beatrice Kirubi: contribution to study search, evaluation of included studies, data extraction, data analysis, contribution to writing Tom Wingfield: contribution to protocol, selection of studies, contribution to writing and editing. Kerri Viney: Contribute to protocol, Study selection, Contribute to writing and editing Delia Boccia: Contribute to protocol, Contribute to writing and editing. Salla Atkins: study conceptualization, protocol writing, study selection, assessment of study quality and richness, data analysis, writing, editing.
