Article Text
Abstract
Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.
- Autonomy
- Behaviour Modification
- Distributive Justice
- Philosophical Ethics
- Public Health Ethics
Statistics from Altmetric.com
Footnotes
Contributors CBK conducted the research and drafted the manuscript as part of her doctoral thesis research. MWM oversaw this research, engaged in critical refinement of the framework and the approach for its development, and helped to edit the manuscript for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Linked Articles
- The concise argument
Read the full text or download the PDF:
Other content recommended for you
- Impact of conditional cash transfer programmes on antenatal care service uptake in low and middle-income countries: a systematic review
- Not just money: what mothers value in conditional cash transfer programs in India
- Women and health professionals’ perspectives on a conditional cash transfer programme to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomised controlled study
- Effect of a conditional cash transfer programme on infant up-to-date and timely vaccination
- The effects of a household conditional cash transfer programme on coverage and quality of antenatal care: a secondary analysis of Indonesia’s pilot programme
- The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis
- Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts
- Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania
- Effects of women’s economic empowerment interventions on antenatal care outcomes: a systematic review
- Impact of conditional and unconditional cash transfers on health outcomes and use of health services in humanitarian settings: a mixed-methods systematic review