Increasing the use of formal care around the time of birth is seen as a key strategy for improving maternal and child health. Yet, worldwide, about 60 million births annually take place outside of health institutions. The majority of these births take place at home, assisted by informal birth attendants, relatives, and in some cases no one. In sub-Saharan Africa and South Asia, the two regions that account for 86% and 75% of maternal and newborn deaths, only 43 percent and 42 percent of women, respectively, deliver in a health facility compared to 99% in Europe and North America. It has been estimated that increasing the use of skilled care during childbirth could prevent up to 1.5 million maternal and newborn deaths and stillbirths by 2025. Conditional cash transfer programs, in which women receive cash payments conditioned on the use of maternal health services, are increasingly being used as a mechanism to increase deliveries in health facilities in low and middle-income countries. In this randomized controlled trial, we study the effectiveness of a cash transfer scheme that targets higher-risk women. Though CCT (and other demand-side) programs are popular, there is growing recognition that investments will need to be made on the supply-side in order to realize the full potential of programs that incentivize households to use services. Many studies document the existence of supply-side constraints and there is evidence that these may constitute important barriers to use of delivery care and improvement in health outcomes. In this study, we randomly assign selected primary health care clinics to receive discretionary cash grants and study the impact on service delivery, utilization, and health outcomes.
This randomized controlled trial will evaluate the effectiveness of a targeted conditional cash transfer scheme to increase use of delivery care by high-risk women, and the effectiveness of a program providing small cash grants to health facilities to improve quality of service delivery.