The impact of two decades of conditional cash transfers on child health in Latin America: An integrated evaluation and forecasting analysis to mitigate effects of the economic crisis

Background: The COVID-19 pandemic, Climate change, and Conflict/war(3C’s) slowed down the progress of the achievements of the Sustainable Development Goals(SDGs), and they even reversed years of progress in child deaths. On the other hand, social programs can contribute to mitigating these effects. We aimed to investigate the effect of conditional cash-transfer programs(CCT) coverage on child health in Latin-America and the Caribbean(LAC) and forecast the relationship between these programs and under-five mortality rate(U5MR) up to 2030 in the context of the 3C’s and current global economic crisis. Methods: This study has a multicountry municipal-level design, covering 7,204 municipalities in Brazil, Ecuador, and Mexico(BEM). We estimated the impact of CCT target coverage on child hospitalizations and mortality, adjusting for relevant factors, using fixed-effects negative binomial models in 4,882 municipalities with adequate quality of civil registration and vital statistics(CRVS) from 2000-19. Several sensitivity analyses were performed to warranty the robustness of results, including difference-in-difference(Diff-in-diff) with propensity-score matching(PSM) like a triangulation approach. Thereafter, we integrated this with validated dynamic microsimulation models, projecting U5MR trends for 7,204 municipalities up to 2030. Results: High coverages of CCT programs were associated with a statistically significant reduction in child, infant, and post-neonatal mortality rates, with rate ratios(RR) of 0·76(95%CI:0·75-0·76), 0·73(95%CI:0·72-0·73), and 0·69(95%CI:0·68-0·70), respectively; avoiding 738,919(95%CI:695,641-782,104) child deaths between 2000-19 in the hypothetical case these programs did not exist. The effect of consolidated CCT coverage was highest on poverty-related U5MR such as malnutrition 0·33(95%CI:0·31-0·35), HIV-AIDS 0·32(95%CI:0·28-0·37), diarrhea 0·41(95%CI:0·40-0·43), and lower-respiratory infections 0·66(95%CI:0·65-0·68). Considering a scenario of moderate economic crisis, a mitigation strategy that increases the coverage of CCT proportionally to the increase of poverty could avert 114,513(95%CI:93,846–135,896) deaths by 2030. Conclusion: CCT could strongly reduce childhood hospitalization and mortality in LAC and their expansion should be considered an effective mitigation strategy for the adverse health impact of the current global economic crisis.