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Interventions with incentives; conditional-cash transfers, voucher schemes, material rewards
|
| Agha S. Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: Results from a demand-side financing intervention. International Journal for Equity in Health 2011;10∶57. |
2011 |
Rural Pakistan |
Vouchers distributed to pregnant women from poor households admitting free antenatal, delivery and postnatal care. Health providers reimbursed for received vouchers. |
Repeated cross-sectional study comparing women from 10 intervention councils and 10 control councils. |
Significant increases in institutional delivery rate among poor women in intervention area compared to non-poor and control area. Non-significant effect on ANC and PNC use and no effect on family planning |
5.2; 5.5 |
Moderate |
| Agha, S. Impact of a maternal health voucher scheme on institutional delivery among low income women in Pakistan. Reprod Health 2011; 8∶10. |
2011 |
Dera Ghazi Khan City, Pakistan |
Vouchers distributed to pregnant women from poor households admitting free antenatal, delivery and postnatal care. Health providers reimbursed for received vouchers. |
Cross-sectional study comparing randomly selected women who delivered before and during the intervention period. |
The change in use of ANC and institutional delivery varied between different income groups. ANC use increased mostly in the middle quintiles, while institutional delivery rate increased among the poorest. |
5.2; 5.5 |
Strong |
| Ahmed S. & M.M. Khan. Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Soc Sci Med, 2011; 72(10): 1704–10. |
2011 |
Rural Bangladesh |
Vouchers distributed to all pregnant women in the study area admitting free antenatal, delivery and postnatal care. Health providers reimbursed for received vouchers. |
Non randomized trial with one intervention and one control area |
Voucher recipients were more likely to deliver at a health facility and to attend antenatal care compared to non-recipients. The largest effect of the voucher scheme was seen among the poor recipients. |
5.2; 5.5 |
Moderate |
| Banerjee A.V. et al. Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives. BMJ 2010; 340:c2220. |
2010 |
Rural Rajasthan, India |
Immunization campaign with or without material incentives. |
Clustered randomized controlled study |
Small incentives have large positive impacts on the uptake of immunization services in resource poor areas. |
4.3 |
Strong |
| Barham T. & J.A. Maluccio. Eradicating diseases: the effect of conditional cash transfers on vaccination coverage in rural Nicaragua. Journal of Health Economics 2009; 28∶611–21. |
2009 |
Rural Nicaragua |
Conditional cash transfer to mothers for health (vaccination a and nutrition) and education (workshop) |
Clustered randomized controlled study |
The program led to large increases in vaccination coverage with pronounced effects in hard-to reach populations. |
4.3 |
Strong |
| Barham T. Impact of the Mexican conditional cash transfer program on immunization rates |
2005 |
Mexico |
Conditional cash transfers to families that conveyed to a pre-set health promotion program (Progresa) |
Clustered randomized controlled study |
An increase of three percentage points was seen in the intervention area compared to control area |
4.3 |
Strong |
| Feldman B.S. et al. Contraceptive use, birth spacing, and autonomy: an analysis of the Oportunidades program in rural Mexico |
2009 |
Mexico |
Conditional cash transfer to poor rural pregnant women§ |
Repeated cross-sectional surveys in 1997, 1998, 2000 and 2003 in a cluster-randomized sample. |
Beneficiaries of the program increased their use of modern contraceptives more than controls in the early stage of the program. Later on no difference between intervention and control could be detected. |
5.3 |
Moderate |
| Ir P. et al. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: A case study in three rural health districts in Cambodia. BMC Pregnancy and Childbirth 2010; 10∶1. |
2010 |
Cambodia |
Health equity fund (HEF), vouchers and supplier incentives (performance based contracting) |
Cross-sectional study using data from the routine health information system. |
Increase in facility delivery from 16.3% to 44.9% in intervention area |
5.2 |
Weak |
| Lim S.S. et al. India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet 2010; 375(9730): 2009–23. |
2010 |
India |
Vouchers distributed to pregnant women from poor households admitting free antenatal, delivery and postnatal care and a monetary reimbursement for mothers and health providers after completed services (Janani Suraksha Yojana program). |
Cross-sectional study using data from nationwide district-level household surveys performed in 2002–04 and 2007–09. |
Increases in ANC and facility delivery. However, the poorest and least educated women did not always have the highest odds of receiving cash payments. |
5.2; 5.5 |
Moderate |
| Mavalankar, D. et al. Saving mothers and newborns through an innovative partnership with private sector obstetricians: Chiranjeevi scheme of Gujarat, India. Int J Gynaecol Obstet, 2009;107(3):271–6. |
2009 |
Gujarat, India |
Voucher scheme providing free obstetric care at private providers. |
Cross-sectional study comparing reported data with estimated data. |
Facility-based deliveries increased from 27% to 53%. Estimated improvements in maternal and neonatal mortality |
5.1; 5.2 |
Weak |
| Meuwissen, L. E., Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study. J Adolescent Health 2006; 38∶56.e1-56.e9. |
2006 |
Disadvantaged areas in Managua, Nicaragua |
Voucher scheme targeting male and female adolescents in disadvantaged areas. |
Cross sectional comparison between intervention and control groups. |
At schools, sexually active voucher receivers had a significantly higher use of modern contraceptives than non-receivers. |
5.3 |
Moderate |
| Morris S. S. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 2004; 364∶2030–37. |
2004 |
Rural Honduras |
Monetary vouchers paid to women in households in beneficiary municipalities in addition to resources to local health teams combined with a community-based nutrition intervention. |
Cluster randomized controlled trial comparing intervention and control area before and after intervention. |
The household-level intervention had a large impact (15–20 percentage points; p<0·01) on the reported coverage of antenatal care. Measles immunisation rate was not affected. |
4.3; 5.5 |
Strong |
| Nguyen, H.T.H., et al., Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher program. Social Science and Medicine, 2012; 74(7): 989–996. |
2012 |
32 sub- districts in Bangladesh |
Vouchers distributed to all pregnant women in the study area admitting free antenatal, delivery and postnatal care. Health providers reimbursed for received vouchers. |
Cross sectional comparison between intervention and control groups using data from household survey in 2009. |
Overall increased use of qualified providers for ANC, delivery and PNC with substantially larger program effects among the poorest women. |
5.2,; 5.5 |
Moderate |
| Rob U., M. Rahman & B. Bellows. Using vouchers to increase access to maternal healthcare in Bangladesh. Int Q Community Health Educ 2009; 30(4):293–309. |
2009 |
Bangladesh |
Vouchers distributed to pregnant women from poor households admitting free antenatal, delivery and postnatal care. Health providers reimbursed for received vouchers. |
Repeated cross-sectional before-after intervention. |
Increased ANC, facility delivery and PNC |
5.2; 5.5 |
Weak |
| Sosa-Rubi S.G. et al. Learning effect of a conditional cash transfer programme on poor rural women's selection of delivery care in Mexico. Health Policy Plan 2011; 26(6): 496–507. |
2011 |
Mexico |
Conditional cash transfer to poor rural pregnant women |
Repeated cross-sectional surveys in 1998, 2003 and 2007. |
A so called learning effect was found, illustrating how women with a longer exposure to the program had higher probability of their last delivery to be attended by a skilled personnel vs. Traditional midwife. The most disadvantaged women had however less access to skilled birth attendance. |
5.2; 5.5 |
Moderate |
|
Policy interventions
|
| McQuestion M. J. Evaluating program effects on institutional delivery in Peru. Health Policy 2006; 77∶221–232. |
2006 |
Peru |
SMI Program (provided delivery care coverage to Peru’s poorest households, 1998) and Proyecto 2000 (sought to improve the quality of EmOC and increase utilization of public EmOC facilities, 1996–2002) |
Cross sectional comparison between intervention and control groups |
A mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent. |
5.2 |
Strong |
| Uddin M.J. et al. Improving low coverage of child immunization in rural hard-to-reach areas of Bangladesh: findings from a project using multiple interventions. Vaccine 2012; 30(2):168–79. |
2012 |
Bangladesh |
EPI program in combination with policy change to eliminate barriers relating to geographical boundaries. |
Pre-post intervention surveys |
Increased overall coverage of measles vaccine coverage but |
4.3 |
Strong |
|
Culturally adapted interventions
|
| Meegan, M. E. Effect on neonatal tetanus mortality after a culturally-based health promotion programme. Lancet 2001; 358∶640–41. |
2001 |
Kenya |
Locally recruited traditional birth attendants, whose responsibilities included peer group education, prenatal monitoring, delivery, postpartum follow-up, and referral where necessary, delivered health promotion. Traditional birth attendants were given individual packs for each birth. |
Time-series using cross-sectional data. |
After introduction of the programme, neonatal tetanus rates fell sharply, and by 1988 death rates had dropped to 0·75 (range 0–3) per 1000 births in the intervention areas compared to 82 (74–93) per 1000 in control areas. Death rates in intervention communities did not rise again between 1988 and 1999. Total mortality rates in children aged less than 6 weeks fell from 307 to 50 per 1000 in intervention areas, while they went from 233 to 294 in the control area over the same period. |
4.2 |
Moderate |
