Evaluation of the impact of social safety net program on health care utilization in Togo

Background The use of health care services by the most vulnerable households in low-and middle-income countries is a major challenge. This includes ensuring access to health services and protecting households from the financial risks of unaffordable medical care. In 2008, Togo put in place a social safety net program which aims to help vulnerable households benefit from cash transfers, free health care services, donated bed nets and food supplements. Methods The data come from recent national household surveys in Togo. These are the 2018 Harmonized Household Living Conditions Survey (EHCVM). The sample size of the EHCVM survey is 6171 households. Using propensity scores (PSM) and the endogenous switching regression (ESR) model, we find that basic social nets have little direct effect on health care utilization. Results These results show that households that are beneficiaries of the social safety nets would have had less -80.52% (-0.413/0.5129) use of health care services than if they had not participated in the social safety nets. These results show the indirect effect of the mitigation of social safety nets by policy makers to avoid hunger, malnutrition, poverty, unemployment. All of these strengthen the health status of households by avoiding certain diseases that may lead them to use health care services. Conclusion This paper provides new evidence on the impact of social safety net programs on household health care utilization. Given the voluntary nature of participation in social safety nets by households, we exploit the uneven deployment of the program in rural areas as a natural experiment to explore causal inference. However, they do ensure good health status of households through different transmission channels, which reduces health care utilization. Policy makers should be encouraged to expand this program to other non-beneficiary groups.