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Financial incentives for maternal health: Impact of a national programme in Nepal

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  • Powell-Jackson, Timothy
  • Hanson, Kara

Abstract

Financial incentives are increasingly being advocated as an effective means to influence health-related behaviours. There is, however, limited evidence on whether they work in low-income countries, particularly when implemented at scale. This paper explores the impact of a national programme in Nepal that provides cash incentives to women conditional on them giving birth in a health facility. Using propensity score matching methods, we find that the programme had a positive, albeit modest, effect on the utilisation of maternity services. Women who had heard of the SDIP before childbirth were 4.2 percentage points (17 percent) more likely to deliver with a skilled attendant. The treatment effect is positively associated with the size of the financial package offered by the programme and the quality of care in facilities. Despite the positive effect on those exposed to the SDIP, low coverage of the programme suggests that few women actually benefited in the first few years.

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  • Powell-Jackson, Timothy & Hanson, Kara, 2012. "Financial incentives for maternal health: Impact of a national programme in Nepal," Journal of Health Economics, Elsevier, vol. 31(1), pages 271-284.
    • Handle: RePEc:eee:jhecon:v:31:y:2012:i:1:p:271-284
    DOI: 10.1016/j.jhealeco.2011.10.010
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    2. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series 082, World Institute for Development Economic Research (UNU-WIDER).
    3. Elizabeth Tilley & Isabel Günther, 2016. "The Impact of Conditional Cash Transfer on Toilet Use in eThekwini, South Africa," Sustainability, MDPI, vol. 8(10), pages 1-16, October.
    4. Alan de Brauw & Amber Peterman, 2020. "Can conditional cash transfers improve maternal health care? Evidence from El Salvador's Comunidades Solidarias Rurales program," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 700-715, June.
    5. Witter, Sophie & Somanathan, Aparnaa, 2012. "Demand-side financing for sexual and reproductive health services in low and middle-income countries : a review of the evidence," Policy Research Working Paper Series 6213, The World Bank.
    6. Díaz, Juan José & Saldarriaga, Víctor, 2017. "Promoting prenatal health care in poor rural areas through conditional cash transfers: evidence from JUNTOS in Peru," Avances de Investigación 0025, Grupo de Análisis para el Desarrollo (GRADE).
    7. Gopalan, Saji S. & Mutasa, Ronald & Friedman, Jed & Das, Ashis, 2014. "Health sector demand-side financial incentives in low- and middle-income countries: A systematic review on demand- and supply-side effects," Social Science & Medicine, Elsevier, vol. 100(C), pages 72-83.
    8. Coffey, Diane, 2014. "Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India," Social Science & Medicine, Elsevier, vol. 114(C), pages 89-96.
    9. Tulsi Ram Bhandari & V Raman Kutty & P Sankara Sarma & Ganesh Dangal, 2017. "Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-10, August.
    10. Hiroyuki Egami & Tomoya Matsumoto, 2020. "Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda," Sustainability, MDPI, vol. 12(9), pages 1-34, May.
    11. Mohamad A. Khaled & Paul Makdissi & Rami V. Tabri & Myra Yazbeck, 2018. "A framework for testing the equality between the health concentration curve and the 45‐degree line," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 887-896, May.
    12. Renate Hartwig & Robert Sparrow & Sri Budiyati & Athia Yumna & Nila Warda & Asep Suryahadi & Arjun S. Bedi, 2019. "Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia," Economic Development and Cultural Change, University of Chicago Press, vol. 67(3), pages 659-686.
    13. Paula von Haaren & Stefan Klonner, 2021. "Lessons learned? Intended and unintended effects of India's second‐generation maternal cash transfer scheme," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2468-2486, September.
    14. Rahman, Mohammad Mahbubur & Pallikadavath, Saseendran, 2018. "How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India," Economics & Human Biology, Elsevier, vol. 31(C), pages 164-183.
    15. Joshi, Shareen & Sivaram, Anusuya, 2014. "Does it Pay to Deliver? An Evaluation of India’s Safe Motherhood Program," World Development, Elsevier, vol. 64(C), pages 434-447.
    16. Fredrick Manang & Chikako Yamauchi, 2015. "The impact of access to health facilities on maternal care use and health status: Evidence from longitudinal data from rural Uganda," GRIPS Discussion Papers 15-19, National Graduate Institute for Policy Studies.
    17. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    18. Tulasi Malini Maharatha & Sumirtha Gandhi & Umakant Dash, 2021. "Has the Demand and Supply-side Components of Janani Suraksha Yojana Augmented the Uptake of Maternal Health Care Services among Poor Women in India ? : An Application of Hybrid Matching Technique," BASE University Working Papers 08/2021, BASE University, Bengaluru, India.
    19. Duong, Pham Bao & Thanh, Pham Tien, 2019. "Adoption and effects of modern rice varieties in Vietnam: Micro-econometric analysis of household surveys," Economic Analysis and Policy, Elsevier, vol. 64(C), pages 282-292.
    20. Pham Bao Duong & Pham Tien Thanh & Tihomir Ancev, 2021. "Impacts of off‐farm employment on welfare, food security and poverty: Evidence from rural Vietnam," International Journal of Social Welfare, John Wiley & Sons, vol. 30(1), pages 84-96, January.
    21. Grépin, Karen A. & Habyarimana, James & Jack, William, 2019. "Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya," Journal of Health Economics, Elsevier, vol. 65(C), pages 15-30.
    22. Somdeep Chatterjee & Prashant Poddar, 2021. "From Safe Motherhood to Cognitive Ability: Exploring Intrahousehold and Intergenerational Spillovers," Economica, London School of Economics and Political Science, vol. 88(352), pages 1075-1106, October.
    23. von Haaren, Paula & Klonner, Stefan, 2020. "Maternal cash for better child health? The impacts of India’s IGMSY/PMMVY maternity benefit scheme," Working Papers 0689, University of Heidelberg, Department of Economics.
    24. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series wp-2016-82, World Institute for Development Economic Research (UNU-WIDER).
    25. Gerald Manthalu, 2019. "User fee exemption and maternal health care utilisation at mission health facilities in Malawi: An application of disequilibrium theory of demand and supply," Health Economics, John Wiley & Sons, Ltd., vol. 28(4), pages 461-474, April.

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    More about this item

    Keywords

    I10; I18; Impact evaluation; Financial incentives; Demand for health care; Maternal health; Nepal;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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