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Cash-based Interventions for Health programmes in Refugee Settings: A Review

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Introduction

The protection of refugees is firmly embedded in an understanding that human rights underpin all aspects of UNHCR’s international protection work and provide the basic normative framework governing UNHCR’s protection and assistance activities including in Public Health.

In its efforts to assure that refugees are able to fully exercise their fundamental human rights and freedoms, UNHCR promotes the full implementation by States of their obligations under international refugee and human rights law as provided for, inter alia, in the 1951 Convention relating to the Status of Refugees, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Cultural and Social Rights.

UNHCR aims to enable refugees to maximise their health status by supporting them to have equal access to quality primary, emergency and referral health services as nationals. The different settings of UNHCR ’s operation, however, pose challenges due to the wide variety of healthcare systems, healthcare financing models and disease patterns and burdens, in each region, country and even sub-nationally within a country.

Since the early 1990s, social protection programmes, often focused on safe motherhood, have demonstrated that financial incentives can stimulate positive health outcomes in development settings. There is little documented evidence of the use of cash-based interventions (CB Is) for health services in the humanitarian context, except to provide access to healthrelated products (such as insecticide-treated bed nets) or to support nutrition.
The objectives of this review are to explore the following:

  1. What does the literature say about the use of cash and vouchers to achieve health outcomes?

  2. What are the lessons learned and how can these be applicable for UNHCR ’s public health programmes?

Section one reviews relevant experience from development settings. Section two presents case studies using CB Is for health in refugee settings, and consolidates these experiences to extract elements of good practice. Finally, section three draws conclusions and makes some careful recommendations for CB I for health programme design and implementation by UNHCR.