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Am J Public Health. 2011 Aug;101(8):1365-9. doi: 10.2105/AJPH.2011.300140. Epub 2011 Jun 16.

Using conditionality as a solution to the problem of low uptake of essential services among disadvantaged communities: a social determinants view.

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  • 1UCL Epidemiology and Public Health, London, UK.


Conditional cash transfer schemes, which use cash to incentivize uptake of basic health and educational services, are well established among social planners inlow- and middle-income countries and are now taking hold in high-income countries. We appraised these schemes within a social determinants framework and found some encouraging signs in their first decade of operation. Success, however, has been inconsistent, and it is unclear whether conditional cash transfer schemes can reliably secure meaningful improvements in participants' health and nutritional status or educational attainment. Conditional cash transfer schemes' objectives will not be met unless they are transformed in 3 ways: transferring power as well as resources, emphasizing entitlements alongside conditionality, and avoiding the trap of incoherent or residualized policy.

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