Preventing household financial hardship from severe illness: The role of cash transfers

Background. Severe illness, like that caused by the infectious disease tuberculosis (TB), is associated with direct expenses accessing healthcare, and indirect costs from time away from work. Cash transfers, which provide regular income transfers to eligible vulnerable households, might improve the coping capacity of poor households. This PhD aimed to investigate whether cash transfers prevent household financial hardship from severe illness. Objectives. 1. Evaluate the effect of cash transfers on changes in household income and consumption in response to severe illness. 2. Assess uptake of social protection and financial hardship amongst drug resistant TB affected households. 3. Evaluate the most effective and affordable approach for delivering cash transfers to prevent household financial hardship related to TB. Methods. Systematic review of conditional cash transfers, income shocks, and household coping; historical cohort study of self-reported severe illness and changes in household labour income and food consumption; cross-sectional survey of notified drug resistant TB costs; economic modelling of cash transfers and catastrophic TB-related costs in seven countries. Results. Systematic review identified 5 studies, which together indicate that conditional cash transfers improve households’ capacity to safeguard consumption in response to shocks. Panel data analysis found no effect of self-reported severe illness on household labour income or food consumption. Cross-sectional analysis indicated that uptake of social protection, including cash transfers, reduces the likelihood of experiencing financial hardship because of drug resistant TB. In economic modelling, providing cash transfers to defray TB-related costs was more effective and affordable for preventing catastrophic costs than providing cash transfers to reduce poverty amongst households vulnerable to TB. Conclusion. Cash transfers appear to enhance the capacity of poor households to cope with severe illness. However, it remains unclear if cash transfers as currently implemented are sufficient to ensure that every household is able to meet their basic needs.