However this process of government led contracting

However, this process of government-led contracting within the context of fragile states raises many important research questions. These questions range from its effect on government legitimacy to health system fragmentation, and long-term sustainability, efficiency, and equitability. Research on some of these issues has been done to a certain degree in fragile states such as Afghanistan. Nevertheless, the dissemination of results has been slow to reach policy makers. So far, no such research has been undertaken within Somalia, mainly because of low prioritisation by humanitarian and government bodies, and scarce local capacity to undertake this type of longitudinal research.
The report by Lucie Cluver and colleagues (December, 2013) is a welcome effort to document the effects of the child support grant in South Africa and shows the complexities of assessment of cash transfers in programmatic settings. The Article raises several questions which would benefit from further consideration. With regard to study design, the study is described both as a case-control study and as a prospective observational study. It is not clear that the same adolescents were interviewed at baseline and follow-up. It seems in table 1 as if different adolescents were interviewed, since among both sexes, from AS1842856 not in receipt of the grant, there were fewer maternal and paternal orphans at follow-up and a more than 10 percentage point difference in the prevalence of both sexes living in informal housing (fewer at follow-up). This shift is fairly large over a 1 year period, which could point to other improvements in social status of these households that could affect sexual risk behaviour. The investigators conclude that this study provides evidence of feasibility and scalability of child-focused cash transfers as an HIV prevention method. We would like to add some caution to this message. Although socioeconomic status is among the social determinants of health, it cannot realistically be expected that a small cash transfer to mothers should result, by itself, in changes in adolescent sexual risk behaviour. There has been much discourse regarding the adequacy of the child support grant to meet even basic needs of children. At US$35, the child support grant is not likely to be used for high-value social items (eg, clothing, hair products, mobile phones), which are known to underlie poor girls\' motivations for engaging in transactional sex. The child support grant presents immense opportunities as a policy instrument for alleviation of child poverty in South Africa, but we argue that to reach its full potential the value of the grant needs to be higher. In its current form root hairs is not a magic bullet for HIV prevention and there is a danger in oversimplifying the complex mix of challenges of living in poverty and of solutions that might be needed to improve the health and wellbeing of vulnerable families.
We welcome the comments of Tanya Doherty and colleagues, in particular the excellent point that consideration should be given to raising cash transfer values to further alleviate poverty. Whether raising the value of cash transfers would increase the effects on adolescent HIV-risk behaviour is an empirical question, and deserves testing. Indeed, in a World Bank study in Tanzania, changes in sexual behaviour were noted with higher rates of cash transfer but not with lower rates. We also agree that cash transfers are not a so-called magic bullet, and accordingly suggested that they “might be most effective as part of a combination of prevention methods”.
Andrea Nove and colleagues (March, 2014) report compelling and much-needed evidence on the global age pattern of maternal mortality. Their analysis concludes that the excess mortality risk faced by mothers aged 15–19 years might be “less than previously believed”. As the authors point out, this evidence is consistent with our own similar analysis of data from a smaller number of countries.