# Implementation and effects of social protection programs for children, older adults, and people with disabilities in Brazil and Ecuador: A scoping review

## TL;DR

This study reviews social protection programs in Brazil and Ecuador to understand their effects on health and socioeconomic factors for vulnerable groups.

## Contribution

The study provides a comprehensive scoping review of social protection programs in Brazil and Ecuador, highlighting gaps in evidence for older adults and people with disabilities.

## Key findings

- Brazil's BFP has substantial evidence on planned effects for children but limited data on unplanned effects in adults.
- Ecuador's BDH has some evidence on health effects but lacks data on socioeconomic determinants and unplanned effects.
- Few studies in both countries use longitudinal data or comparison groups, and program coverage varies widely.

## Abstract

We conducted a scoping review to investigate planned (intentional) and unplanned (not intentional) effects of social protection on socioeconomic determinants of health (SDH) and health inequalities among children, adolescents, elders and people with disabilities, and their caregivers. We reviewed seven programs in (i) Brazil (Programa Bolsa Familia (BFP) and Beneficio de Prestacao Continuada (BPC)), and (ii) Ecuador (Bono de Desarrolo Humano (BDH), Bono 1000 días, Pensión Mis Mejores Años/Pensión para Adultos Mayores, Pensión Toda una Vida/Pensión para personas con discapacidad and Bono Joaquín Gallegos Lara). We searched PubMed, EMBASE, LILACS, Scopus, Econlit, PsycINFO, Global Health, Global Index Medicus and grey literature for studies evaluating program implementation and effects on health outcomes or SDH from 1990 to 2023. We extracted data from 114 studies (84 on BFP, 17 on BDH and 13 on BPC). No studies were identified for the remaining programs. In Brazil, we found substantial evidence of BFP planned effects on children’s health and some SDH but little evidence on its unplanned effects in adults and caregivers. Evidence effects of BPC on health outcomes were scarce, with only one study in elders and none among people with disabilities. In Ecuador, we found evidence only for BDH, with some studies on planned health effects and few on SDH and its unplanned effects. Very few studies used longitudinal data, quasi-experimental designs, or comparison groups of eligible non-recipients. Finally, we found large variations coverage and implementation of programs. In summary, our review highlights the lack of evidence on the overall impacts of social protection in Ecuador, particularly those targeting older adults and people with disabilities. In Brazil, further research is needed on unplanned health effects of the BFP and on the impacts of social protection targeting elders and people with disabilities.