ABSTRACT In spite of the consistent evidence of cash transfers’ (CTs) impact on the social determinants of health (SDoH) in low-and middle-income countries, and their potential for achieving health sector objectives, there is a growing concern that the health sector has not been actively involved in these programs. This study used a critical realist approach to examine the factors affecting health sector involvement in CTs in Ghana. In-depth semi-structured interviews were conducted with 20 health promoters comprising national policymakers, District Directors of Health Service, Regional/District Health Promotion Managers and health promotion academics between October 2017 and February 2018. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. In addition, policy documents concerning the Ghana CT program were reviewed. All the participants were aware of the CT program, but had limited or no involvement in it to date. The findings indicate that CTs’ cross-cutting goals and health sector mandates and responsibilities constitute the key structures and powers with the potential to trigger a more substantive involvement of the health sector in the program. Factors found to shape health sector involvement in CTs included CT policymakers’ understanding of the SDoH, national health sector leadership, evidence linking CTs to SDoH, intersectoral collaboration and politicisation of CTs. As CTs continue to adapt and expand across low-and middle-income countries, the findings from this study can help the health sector to take a more substantive role in the programs to optimise their impacts on the SDoH and health inequities.

中文翻译：

---

影响卫生部门参与解决健康问题社会决定因素的公共政策的因素：加纳现金转移的关键现实案例研究

摘要 尽管现金转移 (CT) 对低收入和中等收入国家健康的社会决定因素 (SDoH) 的影响及其实现卫生部门目标的潜力有一致的证据，但人们越来越担心部门并未积极参与这些计划。本研究使用批判现实主义方法来检查影响加纳卫生部门参与 CT 的因素。2017 年 10 月至 2018 年 2 月期间，对 20 位健康促进者进行了深入的半结构化访谈，其中包括国家政策制定者、地区卫生服务主任、区域/地区健康促进经理和健康促进学者。专题框架分析。此外，审查了有关加纳 CT 计划的政策文件。所有参与者都知道 CT 计划，但迄今为止参与有限或没有参与。调查结果表明，CT 的跨领域目标和卫生部门的任务和责任构成了关键结构和权力，有可能引发卫生部门更实质性地参与该计划。发现影响卫生部门参与 CT 的因素包括 CT 决策者对 SDoH 的理解、国家卫生部门的领导、将 CT 与 SDoH 联系起来的证据、跨部门合作和 CT 的政治化。随着 CTs 在低收入和中等收入国家不断适应和扩展，