Principal Investigator: Mylene Lagarde
Start Date: 01 April 2019
End Date: 31 March 2021
Regions: Latin America
Countries: El Salvador
Keywords: Conditional cash transfer, health financing, behaviours, cardiovascular disease, low and middle income countries

Conditional cash transfers (CCT) have proved to be effective health-financing tools to complement universal health coverage (UHC) efforts in Latin America, in tackling underutilisation of essential health services among disadvantaged groups. CCTs traditionally targeted preventive behaviours for communicable, nutritional or maternal and child health (CN-MCH) conditions, with notable successes in improving health service utilisation. However, a rapid shift in the region's disease burden from CN-MCH to non-communicable diseases (NCDs) in recent years - particularly cardiovascular diseases (CVDs), which are now the leading causes of death and disability in Latin America - and concurrent challenges of financing UHC efforts with limited public budgets, raises the question of if and how past CCT successes can be replicated in tackling NCDs, and be done in more cost-effective ways. This question has been largely neglected in academic and policy circles to date.

The growing cardiovascular disease (CVD) epidemic in low and middle-income countries (LMIC) demands innovative approaches to ensure both cost-effective delivery and sufficient take-up of screening services for modifiable CVD risks. By generating evidence on both novel demand-side health financing approaches and a systematic CVD risk screening intervention targeting disadvantaged groups, this research holds potential to ultimately benefit patient health in LMIC. Immediate beneficiaries will be:

• Policymakers in El Salvador and other LMIC, and international development stakeholders (advisors, donors, implementers e.g. PAHO, IDB). Research outputs will inform health policies targeting CVDs, and non-communicable diseases (NCD) in general, in LMIC
• Micro-finance organisations (MFI), including ASEI. MFIs are increasingly integrating health services in their operations for sustainability reasons. The research will support their understanding of the factors driving preventive healthcare use among clients, and novel ways to leverage their group-lending models to improve clients' health-seeking behaviours
• Academic community. This group includes health systems and public health researchers, development and health economists, and students. We expect the study to advance academic research on health systems strengthening for the prevention and early detection of NCDs, and contribute to qualitative and experimental research on determinants of demand for preventive care and social influences on health-seeking behaviours in LMIC