Impact of Cash for Health Assistance on Healthcare Access and Health-Seeking Behaviors for Families of Pregnant Women in Sindh, Pakistan.

BACKGROUND: The 2022 Pakistan floods devastated healthcare access for pregnant women in already impoverished areas in Sindh province. This study examines how Cash for Health assistance (CH) of USD 112 alleviated financial burdens and improved maternal health outcomes and resilience, bridging a critical literature gap on cash effectiveness in humanitarian crises. METHODOLOGY: This study used a mixed-methods approach to assess the CH assistance intervention for families of pregnant/lactating women in flood-affected rural Sindh, Pakistan. A pre-post quantitative analysis of baseline (May-June 2024) and endline (August-November 2024) survey data in ~100 villages (Jamshoro/Sehwan) examined changes in healthcare access, expenditure, and preferences using t-tests, proportion tests, and multivariable regression. Concurrently, five qualitative case studies from key informant interviews provided thematic content analysis, triangulating findings on economic, health, and social impacts. RESULTS: Respondents predominantly had low literacy rates and were from households of daily wage laborers in vulnerable, flood-affected areas. While income and education remained low, instances of forgone care due to financial barriers increased (68% to 97%, p < 0.001). CH significantly improved healthcare access (58% to 98%, p < 0.001). Access to regular physicians (20% to 69%) and private facilities (10% to 41%) notably expanded. Healthcare expenditure significantly increased from USD 9.3 to USD 25, with a shift in spending preference towards medication, consultations, and diagnostics. CH also significantly improved food security (21% to 97%), meal frequency, and overall household stability, including reducing domestic violence. Qualitative data emphasized pre-existing vulnerabilities and CH's role in addressing health, nutrition, and psychosocial needs. CONCLUSIONS: CH significantly improved healthcare access and reduced financial burdens for vulnerable pregnant women post-disaster. However, a sustainable impact requires integrated "cash plus" models, combining financial aid with stronger health systems, psychosocial support, and literacy for long-term resilience.