Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?

Abstract Background Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service...

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Main Authors: Benjamin M. Hunter, Susan F. Murray
Format: Article
Language:English
Published: BMC 2017-08-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12884-017-1445-y
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spelling doaj-259f0422a37440c6bc8c912f49a70e142020-11-25T00:29:41ZengBMCBMC Pregnancy and Childbirth1471-23932017-08-0117112810.1186/s12884-017-1445-yDemand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?Benjamin M. Hunter0Susan F. Murray1King’s College London, Department of International DevelopmentKing’s College London, Department of International DevelopmentAbstract Background Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service utilisation by offsetting some financial costs for users, or increasing household income and incentivising ‘healthy behaviours’. This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health. Methods A secondary analysis (using an adapted Supporting the Use of Research Evidence framework – SURE) was performed on studies that had previously been identified in a systematic review of evidence on DSF interventions in maternal and newborn health. Results The article draws on findings from 49 quantitative and 49 qualitative studies. The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining quality of care under increasing demand. Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there was inadequate health infrastructure and human resources, shortages of medicines and problems with corruption. Studies that documented improved care-seeking indicated the importance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women’s groups. Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF programmes as part of broader maternal and newborn health initiatives would need to take into account these barriers, the behaviours of staff and the quality of care in health facilities. Research is still needed on the policy context for DSF schemes in order to understand how they become sustainable and where they fit, or do not fit, with plans to achieve equitable universal health coverage.http://link.springer.com/article/10.1186/s12884-017-1445-yDemand-side financingVouchersCash transfersMaternal healthNewborn healthImplementation
collection DOAJ
language English
format Article
sources DOAJ
author Benjamin M. Hunter
Susan F. Murray
spellingShingle Benjamin M. Hunter
Susan F. Murray
Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
BMC Pregnancy and Childbirth
Demand-side financing
Vouchers
Cash transfers
Maternal health
Newborn health
Implementation
author_facet Benjamin M. Hunter
Susan F. Murray
author_sort Benjamin M. Hunter
title Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
title_short Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
title_full Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
title_fullStr Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
title_full_unstemmed Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
title_sort demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?
publisher BMC
series BMC Pregnancy and Childbirth
issn 1471-2393
publishDate 2017-08-01
description Abstract Background Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service utilisation by offsetting some financial costs for users, or increasing household income and incentivising ‘healthy behaviours’. This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health. Methods A secondary analysis (using an adapted Supporting the Use of Research Evidence framework – SURE) was performed on studies that had previously been identified in a systematic review of evidence on DSF interventions in maternal and newborn health. Results The article draws on findings from 49 quantitative and 49 qualitative studies. The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining quality of care under increasing demand. Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there was inadequate health infrastructure and human resources, shortages of medicines and problems with corruption. Studies that documented improved care-seeking indicated the importance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women’s groups. Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF programmes as part of broader maternal and newborn health initiatives would need to take into account these barriers, the behaviours of staff and the quality of care in health facilities. Research is still needed on the policy context for DSF schemes in order to understand how they become sustainable and where they fit, or do not fit, with plans to achieve equitable universal health coverage.
topic Demand-side financing
Vouchers
Cash transfers
Maternal health
Newborn health
Implementation
url http://link.springer.com/article/10.1186/s12884-017-1445-y
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