In 2024, Brazil celebrated the 20th anniversary of the Bolsa Família Programme (BFP), one of the world’s largest conditional cash transfer initiatives. A new study published in The Lancet Public Health shows that the BFP has prevented more than 8.2 million hospitalisations and 713,083 deaths in Brazil between 2004 and 2019 . In addition, it is estimated that an additional 683,721 deaths could be prevented if the programme's coverage is expanded by 2030.
These programmes provide cash transfers to low-income families, often with school-age children, provided they meet certain conditions, such as ensuring school attendance and up-to-date vaccinations. The aim is to reduce short-term poverty while breaking the intergenerational cycle of poverty. This is crucial in the current context of polycrisis —multiple crises (armed conflict, rising inflation, climate crisis…) interacting in such a way that their combined impact is greater than the sum of their parts.
The study, coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, and in collaboration with the Institute for Collective Health of the Federal University of Bahia (Brazil), combines real-world data with predictive microsimulation models to evaluate the impact of the programme over the last two decades and estimate the potential impact of its expansion until 2030.
High programme coverage was associated with significant reductions in both mortality and hospitalisation rates across the population. The greatest benefits were seen in child mortality—especially among children under five , with a 33% reduction—and in hospitalisation among people over 70 , with a 48% reduction.
The analysis also shows that the benefits of the programme were greatest in communities with a higher burden of disease. “The Bolsa Família Programme has contributed not only to reducing poverty, but also to lowering territorial health inequalities,” explains Davide Rasella , ISGlobal researcher and coordinator of the study. “By highlighting this impact, we underline the importance of integrated public policies that combine social protection with access to essential services,” he adds.
The study highlights the crucial role that conditional cash transfer programmes can play in advancing the Sustainable Development Goals (SDGs), in particular SDG 3 (good health and well-being), SDG 1 (no poverty), and SDG 10 (reduced inequalities).
Using simulation models, the research team projected three possible scenarios for the BFP to 2030: an expansion scenario, a maintenance scenario, and a third scenario with reductions due to fiscal austerity . In the expansion scenario, more than 8 million additional hospital admissions and 683,000 additional deaths could be avoided compared to the baseline. In contrast, a reduction in coverage would lead to a significant increase in mortality and put greater pressure on the health system .
“In the current context of declining global humanitarian aid and fiscal pressures, it is particularly timely to highlight the positive impact of one of the world’s largest conditional cash transfer programmes,” says Daniella Cavalcanti , first author of the study.
The impact of the Bolsa Família Programme is also in line with the principles of the Global Alliance Against Hunger and Poverty, an initiative endorsed by world leaders at the latest G20 summit in Brazil in 2024. “Brazil’s experience adds value to this global discussion and positions the BFP as a source of inspiration for other countries,” concludes Rasella .
Reference
Medeiros Cavalcanti, D., Ordoñez, J. A., Ferreira da Silva, A., Landin Basterra, E., L Moncayo, A., Chivardi, C., Hessel, P., Pietro Sironi, A., Paes de Sousa, R., Campello, T., Eugênio Souza, L., & Rasella, D. (2025). Health effects of the Brazilian Conditional Cash Transfer programme on mortality and hospitalisation rates: a retrospective analysis and modelling study. Lancet Public Health . https://doi.org/10.1016/S2468-2667(25)00091-X
The Lancet Public Health
Computational simulation/modeling
People
DR and AFS declare funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (1R01AI152938). All other authors declare no competing interests.