Improving Perinatal Outcomes Using Conditional and Targeted Transfers

项目摘要 在分娩前后增加正规护理的使用被视为改善分娩的一项关键战略。 妇幼保健。然而，全世界每年约有6000万新生儿发生在 卫生机构。这些分娩大多数在家中进行，并得到非正规分娩的协助 服务员，亲戚，在某些情况下没有人。在撒哈拉以南非洲和南亚， 在占孕产妇和新生儿死亡率86%和75%的地区， 在卫生设施分娩的妇女比例分别为10%和10%，而欧洲和北欧的这一比例为99 美国参考据估计，增加分娩期间熟练护理的使用， 到2025年防止多达150万例孕产妇和新生儿死亡和死产。有条件现金 转移支付方案，妇女在使用产妇保健服务的条件下获得现金支付; 越来越多地被用作增加卫生设施分娩的机制 在低收入和中等收入国家。在这个随机对照试验中，我们研究了 针对高风险女性的现金转移计划虽然CCT（和其他需求方） 计划是受欢迎的，人们越来越认识到，投资将需要在 供应方，以实现激励家庭使用的方案的全部潜力 服务许多研究都记录了供应方制约因素的存在，有证据表明， 这些可能构成使用分娩护理和改善健康的重要障碍 结果。在这项研究中，我们随机分配选定的初级卫生保健诊所， 自由支配的现金赠款，并研究对服务提供、利用和健康的影响 结果。

PROJECT SUMMARY Increasing the use of formal care around the time of birth is seen as a key strategy for improving maternal and child health. Yet, worldwide, about 60 million births annually take place outside of health institutions. The majority of these births take place at home, assisted by informal birth attendants, relatives, and in some cases no one. In sub-Saharan Africa and South Asia, the two regions that account for 86% and 75% of maternal and newborn deaths, only 43 percent and 42 percent of women, respectively, deliver in a health facility compared to 99% in Europe and North America. It has been estimated that increasing the use of skilled care during childbirth could prevent up to 1.5 million maternal and newborn deaths and stillbirths by 2025. Conditional cash transfer programs, in which women receive cash payments conditioned on the use of maternal health services, are increasingly being used as a mechanism to increase deliveries in health facilities in low and middle-income countries. In this randomized controlled trial, we study the effectiveness of a cash transfer scheme that targets higher-risk women. Though CCT (and other demand-side) programs are popular, there is growing recognition that investments will need to be made on the supply-side in order to realize the full potential of programs that incentivize households to use services. Many studies document the existence of supply-side constraints and there is evidence that these may constitute important barriers to use of delivery care and improvement in health outcomes. In this study, we randomly assign selected primary health care clinics to receive discretionary cash grants and study the impact on service delivery, utilization, and health outcomes.