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Table 2 Summary of key findings from quantitative studies on short-term cash payments and cash transfers

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

Programme Effect on care-seeking outcomesa Key findings from synthesis of factors influencing implementation
Enablers Barriers
Conditional cash transfers
Comunidades Solidarias Rurales, El Salvador Increased skilled birth attendance and facility births. No effect on antenatal care and postnatal care -Awareness generation during monthly meetings [19]
-Concurrent investments in health facility infrastructure and recruitment of health workers [19]
-Payments made to women (not their husbands) [19]
None stated
Mi Familia Progresa, Guatemala Increased antenatal care. No effect on facility births -Concurrent investments in health facility infrastructure and recruitment of health workers [20] None stated
Programa de Asignación Familia, Honduras Increased antenatal care. No effect on postnatal care -Conditionalities to submit paperwork at health facilities [21] -Poor awareness among women of programme conditionalities [21]
Muthulakshmi Reddy Maternity Benefit Scheme, India Associated with use of public facilities for antenatal care and childbirth -Increased total amount of payments [22] -Delays in receipt of money for women [22]
-Overly bureaucratic process for determining eligibility [22]
-Eligibility criteria that restrict payments to women for her first or second live birth [22]
Program Keluarga Harapan, Indonesia Increased antenatal and postnatal care. Mixed picture of positive and no effect on skilled birth attendance. No effect on facility births -Awareness generation by community-based workers [24] -Poor awareness of the programme among target groups [24]
-Delays in receipt of money for women [24]
-Failure to implement verification systems to penalise households that do not meet conditionalities [24]
-Poor availability of midwives [26]
-High start-up costs [24]
Oportunidades, Mexico Mixed picture of positive and no effect on skilled birth attendance. No effect on antenatal care -Awareness generation during monthly meetings [28, 29] -Perceived poor behaviour of staff at participating hospitals [33]
-Attitudes towards formal maternity care services of family members who do not attend monthly meetings [34]
-Distance to participating facilities [33]
-Cost of travel to health facilities [33]
-Lack of concurrent investment in health facilities [28, 29]
Plan de Atención Nacional a la Emergencia Social (PANES), Uruguay Increased antenatal care. No effect on skilled attendance at birth. -Conditionalities for antenatal care were not enforced [35] -Conditionalities for antenatal care were not enforced [35]
Unconditional cash transfers
Child Grant Programme, Zambia No effect on skilled birth attendance or antenatal care None stated -Lack of concurrent investment in health facilities [36]
Short-term cash payments
CHIMACA programme, China No effect on antenatal care or postnatal care None stated -Payment too small [37]
-Overly difficult process for claiming money [37]
Janani Suraksha Yojana, India Increased skilled birth attendance and facility births. Mixed picture of positive, negative and no effect on antenatal care and postnatal care -Awareness generation by community-based workers [38, 39]
-Round-the-clock opening of health facilities [38, 60]
-Emergency transport programmes [62]
-Accreditation of remote health facilities to reduce travel distances [55]
-Active involvement of state and district officials [55]
-Detailed implementation plans [38]
-Poor awareness of the programme among target groups [63]
-Distance and lack of transport to participating facilities [55, 60]
-Payments not made until after childbirth, thereby reducing incentive for antenatal care [55, 62]
-Delays in receipt of money for women [39, 51, 55, 60, 63]
-Demands for additional or informal payments [39, 60, 63]
-Perceived poor quality of care at participating facilities [39]
-Overly bureaucratic process for determining eligibility [55]
-Inappropriate proxy measures of poverty, such as caste [38]
-Women who travel to another area to give birth [51]
-Delays in recruitment of community-based workers [39]
-Poor awareness of the existence of community-based workers [63]
-Delays in payments for community-based workers [55]
-Increased workloads and reduced quality of care at participating health facilities [55, 62, 63]
-Lack of trained midwives [62]
-Existence of a similar programme – the National Maternity Benefit Scheme [55]
Safe Delivery Incentive Programme, Nepal Increased antenatal care. Mixed picture of positive or no effect on skilled birth attendance and facility births -Awareness generation by women’s groups in communities [77]
-Lack of geographical barriers in the study district [77]
-Universal eligibility [77]
-Output-based reimbursements for providers [77]
-Poor awareness of the programme among target groups [77]
-Delays in receipt of money for women [77]
-Payments not sufficient to cover treatment costs [77]
-Demands for additional or informal payments [77]
-Overly difficult process for claiming money [77]
-Confusion amongst health workers and officials regarding eligibility criteria, sharing of health worker incentives and payment mechanisms for women [77]
SURE-P programme, Nigeria No effect on skilled birth attendance or antenatal care -Prompt payments to pregnant women [78]
-Defined roles and contracts for local banks and for organisations that will develop information systems [78]
-Concurrent programmes to expand availability of maternity care services [78]
-Increased workload at participating health facilities [78]
-High start-up costs including research, advocacy, development of information systems, recruitment of workers for data collection and the logistics and security of payments to pregnant women [78]
  1. aSee systematic review for further details of effect on care-seeking outcomes [14]