Cash transfers and the social determinants of health: Towards an initial realist program theory

Cash transfers are a widely adopted social policy initiative for addressing poverty and vulnerability. Cash transfers' exponential growth in low- and middle-income countries provides a unique opportunity to advance our understanding of how they work to impact the social determinants of health. This article reports on a realist qualitative approach to developing an initial program theory about the role of cash transfers in tackling the social determinants of health. A set of 12 initial hypotheses regarding how cash transfers might work to address the social determinants of health were developed from the data. Cash transfer key mechanisms of change found in the study included political will and leadership and news media framing at the macro level, collaboration and intersectoral working at the meso level, and household motivation, empowerment, choice making, awareness raising and risk-taking behaviour at the micro level. This study has developed initial hypotheses that can be tested and refined in future studies using a realist approach.