Long Term Effects of an Intervention on maternal behavior, child health, and community influence

项目摘要 据信，在关键的产前和围产期保健利用不足， 在解释发展中国家儿童健康状况不佳方面的作用。需求方的创新，往往 包括使用金钱奖励，已被证明可以促使更多的人接受保健服务， 但一个关键的悬而未决的问题是，它们是否会导致健康状况的改善。针对这一 证据缺口我们进行了有史以来第一次大规模的集群随机试验之一的条件 激励2017年，在2,300多个人口普查查点地区， 尼日利亚参加了这次审判。在随机分配到干预组的人群中， 提供14美元的现金支付，如果他们参加了至少三次产前检查，在一个健康的分娩 设施，并参加了一次产后访视。在对照组中，孕妇收到了一份小礼物， 0.43元参加。我们发现，在干预组中， 增加了一倍多，妇女得到了更好的护理质量，最终大大减少了胎儿损失。 和死产，以及儿童死亡率的总体下降。在接下来的R 01中，我们建议回到 研究社区在RCT后约5年。我们有三个主要目标：第一，我们希望 检查激励措施是否对产妇行为有长期影响，第二，我们想衡量 对儿童健康的长期影响，最后，我们想检查是否激励产生 社区溢出。

PROJECT SUMMARY Under-utilization of health care during the critical pre- and perinatal periods is believed to play an important role in explaining poor child health outcomes in developing countries. Demand-side innovations, often involving the use of monetary incentives, have been shown to induce greater uptake of health services, but a key unanswered question has been whether they lead to improvements in health. In response to this evidence gap we conducted one of the first ever large-scale cluster randomized trials of conditional incentives. More than 10,000 pregnant women across more than 2,300 census enumeration areas in Nigeria participated in this trial. In clusters randomly assigned to the intervention, pregnant women were offered cash payments of $14 payable if they attended at least three prenatal visits, delivered in a health facility, and attended one postnatal visit. In control clusters, pregnant women received a small gift worth $0.43 for participation. We found that in the intervention arm utilization of pre- and perinatal care more than doubled and women received better quality care, culminating in a significant reduction in fetal losses and stillbirths, and an overall decrease in child mortality. In this follow-on R01 we propose to return to the study communities approximately 5 years after the RCT. We have three main objectives: first, we want to examine whether the incentives had long run effects on maternal behavior, second, we want to measure long run effects on child health, and finally we want to examine whether the incentives generated community spillovers.