Conditional Cash Transfers for Maternal Health Interventions: Factors Influencing Uptake in North-Central Nigeria.

Fatima Baba-Ari,Mazeda Hossain,Ejemai Amaize Eboreime

doi:10.15171/ijhpm.2018.56

Abstract

Background: Nigeria accounts for a significant proportion of global maternal mortality figures with little progress made in curbing poor health indices. In a bid to reverse this trend, the Government of Nigeria initiated a conditional cash transfer (CCT) programme to encourage pregnant women utilize services at designated health facilities. This study aims to understand experiences of women who register for CCT services and explore reasons behind non-uptake of those women who do not register. Methods: We conducted this study in a rural community in North Central Nigeria. Having identified programme beneficiaries by randomly sampling contact details obtained from the programme database, using snowball sampling method we sourced non-beneficiaries list based on recommendations from beneficiaries and other community members. Thereafter we undertook semi-structured interviews on both beneficiaries and non-beneficiaries and analysed data obtained thematically. Results: Our findings revealed that, while beneficiaries of the programme were influenced by the cash transfers, cash may not be sufficient incentive for uptake by non-beneficiaries of CCT in Nigeria. Factors such as community and spousal influence, availability of free drugs, proximity to health facility are critical factors that affect uptake in our study context. On the other hand, poor programme administration, mistrust for government initiatives as well as poor quality of services could significantly constrain service utilization despite cash transfers. Conclusion: Considering that a number of barriers to uptake of the CCT programme are similar to barriers to maternal health services, it is essential that maternal health services are available, accessible and of acceptable quality to target recipients for CCT programmes to reach their full implementation potential.

Highlights

Available evidence indicates supply-side interventions alone are not sufficient to adequately increase uptake of healthcare services if demand side limitations, such as the population’s poverty level and user fees in health facilities, are not taken into consideration.[1]
De Janvry and Sadoulet opine that the CCT approach is considerably more effective than unconditional cash transfers in altering behaviour once it is established that imposing a condition on behaviour is acceptable, such as in the case of information asymmetry, which is common in healthcare, more so in low- and middle-income country (LMIC) contexts
We found barriers to uptake of CCT services in Nigeria to be similar to general barriers to demand for maternal health services

Summary

Introduction

Available evidence indicates supply-side interventions alone are not sufficient to adequately increase uptake of healthcare services if demand side limitations, such as the population’s poverty level and user fees in health facilities, are not taken into consideration.[1]. Cost of altering behaviour must be much lower through a price than an income effect, the opportunity cost of utilizing services should be a key consideration.[4] Despite these, Fenwick posits that institutionalizing effective national social safety nets such as CCTs depends largely on the broader contextual implementation environment than on the technical design and merits of the interventions.[5,6] CCT programmes have gained increasing popularity and have been recently implemented in several developing countries such as Kenya, Malawi, Cambodia, South Africa, and impact evaluations from these countries show increased health service utilization.[7] Studies from various countries where CCT has been implemented, to improve utilization of maternal health services, have shown varying degrees of effectiveness as it relates to their various sociocultural contexts.[2,3,8,9,10,11] Theoretically, conditional cash incentives in healthcare are expected to subsidise costs of healthcare services,[12] leading to a rise in demand in the provided health services.

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Conclusion