Abstract
BackgroundThis paper describes use of a Conditional Cash Transfer (CCT) programme to encourage use of critical MNCH services among rural women in Nigeria.MethodsThe CCT programme was first implemented as a pilot in 37 primary health care facilities (PHCs), in nine Nigerian states. The programme entitles women using these facilities up to N5,000 (approximately US$30) if they attend antenatal care (ANC), skilled delivery, and postnatal care. There are 88 other PHCs from these nine states included in this study, which implemented a standard package of supply upgrades without the CCT. Data on monthly service uptake throughout the continuum of care was collected at 124 facilities during quarterly monitoring visits. An interrupted time series using segmented linear regression was applied to estimate separately the effects of the CCT programme and supply package on service uptake.ResultsFrom April 2013-March 2014, 20,133 women enrolled in the CCT. Sixty-four percent of beneficiaries returned at least once after registration, and 80% of women delivering with skilled attendance returned after delivery. The CCT intervention is associated with a statistically significant increase in the monthly number of women attending four or more ANC visits (increase of 15.12 visits per 100,000 catchment population, p < 0.01; 95% confidence interval 7.38 to 22.85), despite a negative level effect immediately after the intervention began (-45.53/100,000 catchment population; p < 0.05; 95% CI −82.71 to −8.36). A statistically significant increase was also observed in the monthly number of women receiving two or more Tetanus toxoid doses during pregnancy (21.65/100,000 catchment population; p < 0.01; 95% CI 9.23 to 34.08). Changes for other outcomes with the CCT intervention (number of women attending first ANC visit; number of deliveries with skilled attendance; number of neonates receiving OPV at birth) were not found to be statistically significant.ConclusionsThe results show that the CCT intervention is capable of significant effects on service uptake, although results for several outcomes of interest were inconclusive. Key lessons learnt from the pilot phase of implementation include a need to track beneficiary retention throughout the continuum of care as closely as possible, and avert loss to follow-up.
Highlights
This paper describes use of a Conditional Cash Transfer (CCT) programme to encourage use of critical MNCH services among rural women in Nigeria
This paper intends to provide a comprehensive overview of the steps taken and the lessons learnt in implementing the pilot phase in this complex setting, and draw on available data to monitor the demand for basic health services
Impact on demand short-term enumerators who delivered spot training on record keeping as required. This approach ensures that the main finding of interest – service uptake directly before and after the CCT programme began – is based on internally comparable data both between facilities and over time
Summary
This paper describes use of a Conditional Cash Transfer (CCT) programme to encourage use of critical MNCH services among rural women in Nigeria. This paper provides an early description and discussion of one such intervention by the Federal Government of Nigeria’s Subsidy Reinvestment and Empowerment Programme (SURE-P): the pilot phase of a Conditional Cash Transfer (CCT) programme targeting pregnant women in rural and underserved areas. 22.7% of women in rural areas deliver with a skilled attendant, as against 67.0% in urban areas [1] These patterns are replicated in other key indices of reproductive and child health, which show highly inequitable healthcare coverage and outcomes by household wealth [4]. Strategies for improving these indices by the Federal Government of Nigeria have focussed since 2009 on programmes that can achieve results, in terms of access to healthcare and improved health outcomes This approach has been marked by the integration of new interventions with comprehensive impact evaluations, and most recently by the high-profile target of Saving One
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