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Conditional cash transfer schemes in Nigeria: potential gains for maternal and child health service uptake in a national pilot programme.

Okoli U, Morris L, Oshin A, Pate MA, Aigbe C, Muhammad A - BMC Pregnancy Childbirth (2014)

Bottom Line: 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).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.The results show that the CCT intervention is capable of significant effects on service uptake, although results for several outcomes of interest were inconclusive.

View Article: PubMed Central - PubMed

Affiliation: SURE-P MCH Project Implementation Unit, National Primary Health Care Development Agency, Abuja, Nigeria. okoliu2@gmail.com.

ABSTRACT

Background: This paper describes use of a Conditional Cash Transfer (CCT) programme to encourage use of critical MNCH services among rural women in Nigeria.

Methods: The 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.

Results: From 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.

Conclusions: The 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.

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Related in: MedlinePlus

States selected for CCT Pilot Programme. List of the states selected for the Conditional Cash Transfer (CCT) Pilot Programme, shown on the right of the diagram. The figure shows how these states were selected: first by determining that three states should be represented from each of three tiers of performance in a previous evaluation of the Midwives Service Scheme (MSS) in 2012. For each tier, three states were selected from two of Nigeria’s six geopolitical zones. Abbreviations: FCT, Federal Capital Territory.
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Fig1: States selected for CCT Pilot Programme. List of the states selected for the Conditional Cash Transfer (CCT) Pilot Programme, shown on the right of the diagram. The figure shows how these states were selected: first by determining that three states should be represented from each of three tiers of performance in a previous evaluation of the Midwives Service Scheme (MSS) in 2012. For each tier, three states were selected from two of Nigeria’s six geopolitical zones. Abbreviations: FCT, Federal Capital Territory.

Mentions: The CCT programme is initially being piloted in nine states. These were selected to provide representation from each of the six geo-political zones, and to include three states from each tier of performance in implementing the earlier MSS programme (assessed based on their improvement in key performance indicators), as shown in Figure 1. This cross-section was selected in order to allow for a comparative analysis of states’ experiences implementing the pilot. Each state operates a Steering Committee to oversee the programme, composed of government and civil society representatives from the state and the local government areas where the CCT programme is implemented. A cluster of four PHCs and one general hospital in each state was selected which had sufficient existing infrastructure and human resources for health to be able to handle the basic requirements of the pilot.Figure 1


Conditional cash transfer schemes in Nigeria: potential gains for maternal and child health service uptake in a national pilot programme.

Okoli U, Morris L, Oshin A, Pate MA, Aigbe C, Muhammad A - BMC Pregnancy Childbirth (2014)

States selected for CCT Pilot Programme. List of the states selected for the Conditional Cash Transfer (CCT) Pilot Programme, shown on the right of the diagram. The figure shows how these states were selected: first by determining that three states should be represented from each of three tiers of performance in a previous evaluation of the Midwives Service Scheme (MSS) in 2012. For each tier, three states were selected from two of Nigeria’s six geopolitical zones. Abbreviations: FCT, Federal Capital Territory.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4273319&req=5

Fig1: States selected for CCT Pilot Programme. List of the states selected for the Conditional Cash Transfer (CCT) Pilot Programme, shown on the right of the diagram. The figure shows how these states were selected: first by determining that three states should be represented from each of three tiers of performance in a previous evaluation of the Midwives Service Scheme (MSS) in 2012. For each tier, three states were selected from two of Nigeria’s six geopolitical zones. Abbreviations: FCT, Federal Capital Territory.
Mentions: The CCT programme is initially being piloted in nine states. These were selected to provide representation from each of the six geo-political zones, and to include three states from each tier of performance in implementing the earlier MSS programme (assessed based on their improvement in key performance indicators), as shown in Figure 1. This cross-section was selected in order to allow for a comparative analysis of states’ experiences implementing the pilot. Each state operates a Steering Committee to oversee the programme, composed of government and civil society representatives from the state and the local government areas where the CCT programme is implemented. A cluster of four PHCs and one general hospital in each state was selected which had sufficient existing infrastructure and human resources for health to be able to handle the basic requirements of the pilot.Figure 1

Bottom Line: 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).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.The results show that the CCT intervention is capable of significant effects on service uptake, although results for several outcomes of interest were inconclusive.

View Article: PubMed Central - PubMed

Affiliation: SURE-P MCH Project Implementation Unit, National Primary Health Care Development Agency, Abuja, Nigeria. okoliu2@gmail.com.

ABSTRACT

Background: This paper describes use of a Conditional Cash Transfer (CCT) programme to encourage use of critical MNCH services among rural women in Nigeria.

Methods: The 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.

Results: From 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus