Conditional cash transfer schemes in Nigeria: potential gains for maternal and child health service uptake in a national pilot programme
Conditional cash transfer schemes in Nigeria: potential gains for maternal and child health service uptake in a national pilot programme
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DOI：
10.1186/s12884-014-0408-9
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发表时间：
2014-12-12
影响因子：
3.1
通讯作者：
Muhammad, Ado
中科院分区：
文献类型：
--
作者：
Okoli, Ugo;Morris, Laura;Muhammad, Ado
背景：本文介绍了有条件现金转移（CCT）计划的使用情况，以鼓励尼日利亚农村妇女使用关键的MNCH服务。方法：有条件现金转移支付方案首先作为试点在尼日利亚9个州的37个初级卫生保健机构（PHCs）实施。根据该方案，使用这些设施的妇女如果参加产前护理、熟练分娩和产后护理，可获得最高5 000奈拉（约30美元）的补贴。这项研究还包括来自这九个州的其他88个初级保健中心，它们在没有有条件现金转移支付的情况下实施了标准的一揽子供应升级。在季度监测访问期间，收集了124个设施在整个连续护理过程中每月接受服务的数据。采用分段线性回归的中断时间序列分别估计有条件现金援助方案和一揽子供应方案对服务吸收的影响。结果：2013年4月至2014年3月，20,133名妇女参加了CCT。64%的受益人在登记后至少返回一次，80%在熟练助产士的帮助下分娩的妇女在分娩后返回。尽管在干预开始后立即出现负水平效应（-45.53/10万集水区人口；p < 0.05; 95% CI -82.71至-8.36），但CCT干预与每月参加四次或以上ANC就诊的妇女人数的统计学显著增加相关（每10万集水区人口增加15.12次，p < 0.01； 95%置信区间为7.38至22.85）。怀孕期间每月接受两次或两次以上破伤风类毒素剂量的妇女人数也有统计学上的显著增加（21.65/100,000集水区人口；p < 0.01; 95% CI 9.23 ~ 34.08）。CCT干预的其他结果的变化（参加第一次ANC就诊的妇女人数；熟练助产士接生的人数；出生时接受口服脊髓灰质炎疫苗的新生儿人数）没有统计学意义。结论：结果表明，有条件现金援助干预能够显著影响服务的接受，尽管对几个结果感兴趣的结果尚无定论。从实施试点阶段吸取的主要教训包括，需要在整个连续的护理过程中尽可能密切地跟踪受益人保留情况，并避免后续工作的损失。
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.