Generating Evidence for the Use of Cash Relief for Health Outcomes in Pakistan and Cameroon

Cash relief is an intervention that has proven to be one of the most effective and well-evidenced tools to help vulnerable people survive and recover in emergencies. With an increase in the use of multipurpose cash grants to help households affected by crises to meet a variety of needs, it is necessary to understand the extent to which cash assistance will be useful in enabling individuals to achieve health outcomes. 

This research takes the first step towards addressing the evidence gap to determine the appropriateness and feasibility of cash assistance to achieve health outcomes. Our approach is to collect information on the predictable and unpredictable health needs of beneficiary households, how these needs are currently met, and the role of cash assistance in meeting these needs. In parallel, we will conduct health assessments in the areas where cash programming is ongoing to document the environmental factors necessary (from a supply perspective), such as health services of acceptable quality and quantity, in order to propose the use of cash for the purpose of increasing access to and utilization of health services.

Conclusions

There is often an assumption that in humanitarian settings, affected populations should have, or do have, access to health services free of cost. This study revealed that this is not always the case and the financial costs of care can be debilitating for already vulnerable people. For example, for the duration of the data collection, the percentage of households that met the threshold for incurring catastrophic expenditure for healthcare costs was between 11.7-15.6% across the three sites. In all three sites, the study showed that households reported unpredictable health needs, sought care for these needs, and incurred costs to meet them. ‘Lack of money’ or ‘high cost of care’ were cited as reasons for delaying or not seeking care. Finally, the IRC observed that households use of cash to pay for health services and products increased and use of loans to pay for services decreased during the cash assistance period.This suggests that cash can play a role in reducing the burden of health costs and health related debt. It is not meant to serve as a substitute for availability of high quality services, but as a way to enable households to meet health needs without resorting to negative coping mechanisms.

Recommendations

The results from this study point to a number of recommendations for cash and health actors aiming to design cash programs to enable households to access the required care and/or to avoid negative coping strategies due to a high cost burden of health care.

1. When relevant, health should be included in the ingredient list for the Minimum Expenditure Basket that is typically used to determine the cash transfer value in many humanitarian settings, not as a substitute for availability of high quality services, but to supplement household income to meet health needs.
2. Donors and implementers need to assess and ensure services are truly free for displaced populations in humanitarian settings if that is the expectation determined by the local health cluster.
3. Further research is necessary to understand the root cause of poor uptake of preventive health care services, as well as possible solutions. Although the study highlighted low utilization of these services, it did not conclusively indicate whether the low usage was because of demand, availability of services, or a lack of information/knowledge about preventive health care.