Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

ObjectivesGiven high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation).DesignWe conducted an unblinded 1:1 cluster-randomised controlled trial.Setting48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019.Participants2922 women were recruited to the control and 2522 to the intervention arm.InterventionsAn electronic system recorded attendance and triggered payments to the participant’s mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone.Primary outcomesPrimary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data.ResultsWe found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10).ConclusionsDemand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe.Trial registrationNCT03021070.

Pendistribusian Dana Wakaf dengan Skema Conditional Cash Transfers (CCTs) Sebagai solusi atas Permasalahan Stunting di Indonesia

Indonesia is one of the countries with a very high number of stunting sufferers, in addition to affecting physical conditions in the form of disproportionate growth and development, in the short term stunting will increase morbidity and mortality rates in children under five. In the medium term, it will cause a decline in intellectual and cognitive abilities, and in the long run it has the potential to reduce the quality of human resources and the problem of degenerative diseases in adulthood. As one of the philanthropic instruments in Islam, waqf has the potential to reduce the stunting rate in Indonesia, one way is to distribute waqf using Conditional Cash Transfers scheme. This study aims to offer conditional cash transfer as a scheme in distributing waqf funds to reduce stunting rates in Indonesia. This research uses qualitative methods with a library research approach. The results of this study indicate that waqf can be distributed using the Conditional Cash Transfers scheme to reduce stunting rates by targeting participants who come from poor families who have pregnant women and toddlers, requiring recipients to commit to checking themselves into health facilities, providing waqf funds in the form of nutrition and proper sanitation facilities, and the entire implementation process is supervised by a competent supervisor. The results of this study are expected to be useful for related parties in their efforts to reduce stunting rates in Indonesia. Abstrak: Indonesia merupakan salah satu negara dengan jumlah penderita stunting yang sangat tinggi, selain mempengaruhi kondisi fisik berupa tumbuh kembang yang tidak proporsional, dalam jangka pendek stunting akan meningkatkan angka morbiditas dan mortalitas pada balita. Dalam jangka menengah akan menyebabkan menurunnya intelektualitas dan kemampuan kognitif, dan dalam jangka panjang berpotensi menurunkan kualitas sumberdaya manusia dan masalah penyakit degeneratif di usia dewasa. Sebagai salah satu instrumen filantropis dalam Islam wakaf memiliki potensi untuk menurunkan angka stunting di Indonesia salah satu caranya adalah dengan mendistribusikan wakaf menggunakan skema Conditional Cash Transfers. Penelitian ini bertujuan untuk menawarkan skema conditional Cash Transfers dalam pendistribusian dana wakaf untuk menurunkan angka stunting di Indonesia. Penelitian menggunakan metode kualitatif dengan pendekatan studi kepustakaan. Hasil penelitian ini menunjukkan bahwa wakaf dapat didistribusikan menggunakan skema Conditional Cash Transfers untuk menurunkan angka stunting dengan menargetkan peserta yang berasal dari keluarga miskin yang memiliki ibu hamil dan balita, mensyaratkan komitmen penerima untuk memeriksakan diri ke fasilitas kesehatan, pemberian dana wakaf dalam bentuk nutrisi dan fasilitas sanitasi yang layak serta seluruh proses implementasi tersebut diawasi oleh supervisor yang berkompeten. Hasil dari penelitian ini diharapkan bermanfaat bagi pihak terkait dalam upaya menurunkan angka stunting di Indonesia. ملخص: إندونيسيا هي واحدة من البلدان التي لديها عدد كبير جدًا من المصابين بالتقزم ، بالإضافة إلى التأثير على الظروف المادية في شكل نمو وتطور غير متناسبين ، فإن التقزم على المدى القصير سيزيد من معدلات الإصابة بالأمراض والوفيات بين الأطفال دون سن الخامسة. على المدى المتوسط ​​، سوف يتسبب ذلك في تدهور القدرات الفكرية والمعرفية ، وعلى المدى الطويل لديه القدرة على تقليل جودة الموارد البشرية ومشكلة الأمراض التنكسية في مرحلة البلوغ. باعتبارها واحدة من الأدوات الخيرية في الإسلام ، فإن الوقف لديه القدرة على تقليل معدل التقزم في إندونيسيا ، وتتمثل إحدى الطرق في توزيع الوقف باستخدام نظام التحويلات النقدية المشروطة. تهدف هذه الدراسة إلى تقديم التحويل النقدي المشروط كمخطط في توزيع أموال الوقف لتقليل معدلات التقزم في إندونيسيا. يستخدم هذا البحث الأساليب النوعية مع نهج البحث في المكتبات. تشير نتائج هذه الدراسة إلى أنه يمكن توزيع الوقف باستخدام نظام التحويلات النقدية المشروطة لتقليل معدلات التقزم من خلال استهداف المشاركين الذين ينتمون إلى أسر فقيرة لديها نساء حوامل وأطفال صغار ، مما يتطلب من المستفيدين الالتزام بتسجيل أنفسهم في المرافق الصحية ، وتوفير أموال الوقف. في شكل تغذية ومرافق صحية مناسبة ، ويشرف على عملية التنفيذ بأكملها مشرف مختص. من المتوقع أن تكون نتائج هذه الدراسة مفيدة للأطراف ذات الصلة في جهودها للحد من معدلات التقزم في إندونيسيا.

Systematic Review on the Impact of Conditional Cash Transfers on Child Health Service Utilisation and Child Health in Sub-Saharan Africa

Background: Conditional cash transfers (CCTs) are interventions which provide assistance in the form of cash to specific vulnerable groups on the condition that they meet pre-defined requirements. The impact of conditional cash transfers on children's access to health services and on their overall health has not been established in sub-Saharan Africa.Method: We conducted a systematic review aimed at summarising the available information on the impact of conditional cash transfers on health service utilisation and child health in sub-Saharan Africa. We searched databases for peer-reviewed articles, websites of organisations involved in implementing conditional cash transfer programmes, and Google scholar to identify grey literature. Records were selected based on predefined eligibility criteria which were drawn from a programme impact framework. Records were eligible if one of the following outcomes was evaluated: health services utilisation, immunisation coverage, growth monitoring, anthropometry, illness reported, and mortality. Other records which reported on important intermediate outcomes or described mechanisms significantly contributing to impact were also included in the review. Data items were extracted from eligible records into an extraction form based on predefined data items. Study quality indicators were also extracted into a quality assessment form.Results: Thematic narrative synthesis was conducted using data from nine included records. The review included five cluster randomised evaluations, one quasi-experimental clustered study, one randomised trial at the individual level, one mixed-method study and one purely qualitative study. There was insufficient evidence of an impact of conditional cash transfers on health service utilisation. There was also not enough evidence of an impact on nutritional status. No impact was observed on health status based on illness reports, nor on immunisation rates. None of the included records evaluated the impact on childhood mortality.Conclusions: The findings of this review suggest that a positive impact may be observed in health service utilisation and nutrition, however, this may not translate into improved child health. Further research is needed to understand the mechanisms and pathways by which these interventions work, explore the effect of contextual factors on their impact, and assess their cost implication especially within resource-constrained settings.