Was the Maternal Health Cash Transfer Programme in Nigeria Sustainable and Cost-Effective?
Was the Maternal Health Cash Transfer Programme in Nigeria Sustainable and Cost-Effective?
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DOI：
10.3389/fpubh.2020.582072
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发表时间：
2020
影响因子：
5.2
通讯作者：
Mirzoev T
中科院分区：
文献类型：
--
作者：
Onwujekwe O;Ensor T;Ogbozor P;Okeke C;Ezenwaka U;Hicks JP;Etiaba E;Uzochukwu B;Ebenso B;Mirzoev T
背景资料：尼日利亚政府推出了补贴再投资和赋权方案（SURE-P），孕产妇和儿童保健（MCH），以增加熟练孕产妇保健服务的使用，降低孕产妇死亡率。该方案的资金来自燃料补贴的减少，于2012年10月至2015年4月实施，并纳入了向妇女提供的有条件现金转移，以鼓励使用基于设施的孕产妇服务。我们寻求评估该计划中有条件现金转移部分的增量成本效益和长期影响。研究方法：有条件的现金转移支付（CCT）的影响分析和增量成本效益分析进行了卫生服务的角度对干预费用。这项研究是在阿南布拉州进行的，比较了只接受卫生服务投资的地区和实施有条件现金转移方案的地区。对方案产出进行了间断时间序列分析。这些数据与方案成本计算相结合，以确定每项产出的增量成本。调查结果：从2014年年中到2015年底该计划实施后，向有条件现金转移支付地区的患者提供的孕产妇服务迅速加速。在仅投资于保健服务的地区，每个初级保健中心设施提供服务的费用为52 128美元，而在提供现金转移的设施中，费用为90 702美元。大部分额外费用用于管理现金转移。现金转移支付领域的增量成本为分娩护理572美元，产前护理11美元。如果将该方案作为一项常规服务纳入公共卫生系统，估计交付费用将降至389美元，如果假设2015年的活动水平，则降至188美元。结论：虽然有条件现金援助最初作为一个纵向方案构成，其费用与其他类似方案相比相对较高，但如果纳入主要卫生系统，其费用将大幅下降。还有证据表明，在资助结束后，短期方案可以导致寻求健康行为模式的长期变化。
Background: The Subsidy Reinvestment and Empowerment Programme (SURE-P), Maternal and Child Health (MCH) was introduced by the Nigerian government to increase the use of skilled maternal health services and reduce maternal mortality. The programme, funded out of a reduction in the fuel subsidy, was implemented between October 2012 and April 2015 and incorporated a conditional cash transfer to women to encourage use of facility based maternal services. We seek to assess the incremental cost effectiveness and long term impact of the conditional cash transfer element of the programme. Methods: An impact analysis and incremental cost-effectiveness analysis of conditional cash transfers (CCTs) is undertaken taking a health service perspective toward costs of the intervention. The study was undertaken in Anambra state, comparing areas that received only the investment in health services with areas that implemented the conditional cash transfer programme. An interrupted time series analysis of the programme outputs was undertaken. These were combined with a programme costing to determine the incremental cost per output. Findings: Maternal services provided to patients in conditional cash transfer areas accelerated rapidly from the middle of 2014 until after the programme in late 2015. The costs of providing services in each Primary Health Center facility was US $52,128 in the areas that only invested in health services compared to US $90,702 in facilities that also provided cash transfers. Much of the additional cost was in managing cash transfers. The incremental cost in the cash transfer areas was $572 for delivery care and $11 for antenatal care. If the programme was to be integrated as a regular service in the public health system, the cost of a delivery is estimated to fall to $389 and to $188 if 2015 levels of activity are assumed. Conclusion: Although the cost of CCTs as originally constituted as a vertical programme are relatively high compared to other similar programmes, these would fall substantially if integrated into the main health system. There is also evidence of sustained impact beyond the end of the funding suggesting that short term programmes can lead to a long-term change in patterns of health seeking behavior.
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影响因子：
7.2
作者：
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通讯作者：
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影响因子：
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影响因子：
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