Assessing the operational effectiveness of a maternal and child health (MCH) conditional cash transfer pilot programme in Nigeria

Abstract

Background This paper provides insights into design and implementation of a Conditional Cash Transfer (CCT) pilot programme under the Subsidy Reinvestment and Empowerment Programme on Maternal and Child Health (SURE-P MCH) in Nigeria. The CCT day to day operations were independently assessed, from design to enrollment and pay out, in order to inform future CCT designs and implementation. Methods This study combined a desk review of SURE-P MCH CCT operational documents and retrospective, descriptive cross-sectional survey of 314 primary beneficiaries of the CCT scheme from 29 SURE-P MCH CCT designated health facilities between June – July 2015. The programme implementation manual (PIM) and several CCT monthly reports and articles obtained from the project implementation unit (PIU) were reviewed while structured questionnaire of (16) questions was used for face-to-face interviews with (30–33) CCT beneficiaries drawn from each of eight (8) participating states of Anambra, Bauchi, Bayelsa, Ebonyi, Kaduna, Niger, Ogun, and Zamfara and the Federal Capital Territory (FCT)-Abuja. Findings were analyzed and reported using R* statistical package (version 3.1.2). Subsequently a strengths, weaknesses, opportunities and threats (SWOT) analysis was conducted to identify key challenges and possible recommendations. Results The SWOT analysis indicated a robust design for the CCT programme, which would have enhanced operational effectiveness if implemented as designed. However, the programme faced several implementation challenges. For instance, though 65% of beneficiaries perceived CCT pay-out events to be orderly and well-organized, in some of the pilot states the events were marred with inconsistencies resulting in large crowds and increased waiting time for some beneficiaries. Similarly, only 40% of beneficiaries received the complete N5,000 (USD30) cash incentive, 28% received N1,000 (USD6) while others received either N2000 (USD12), N3000 (USD18) or N4000 (USD24). Conclusion The CCT pilot had a robust design as a result of a successful proof of concept which preceded the pilot roll-out. However, its implementation was marred with several challenges ranging from untimely release of funds, limited monitoring and evaluation and other operational challenges. Future CCT programmes should understudy the SWOT analysis presented in this paper to improve the design and implementation of CCT programmes in Nigeria and other settings.

The annual cost of providing paid maternity leave in the informal sector in Indonesia 

“…However, the proposed MCT approach would require, among other things, sound monitoring to ensure that breastfeeding actually took place, consistency in the best timing of delivery of cash distribution and breastfeeding counselling visits, recognizing that many mothers receiving the cash transfer face major social determinants of health challenges. These need to be addressed through supportive social protection, efficacy evaluation of the intervention, and economic policies [41,42,[68][69][70].…”

Evaluasi Dampak Program Keluarga Harapan Terhadap Pemanfaatan Fasilitas Pelayanan Kesehatan untuk Layanan Persalinan di Indonesia (Analisis Data SUSENAS tahun 2018)

“…Manfaat CCT di Nigeria dalam 2 trimester pertama menunjukan penerima CCT pada wanita mendaftar dan menghadiri kunjungan antenatal (ANC) sebesar 93% dibandingkan dengan tidak menerima CCT (Oduenyi, Ordu and Okoli, 2019). Jumlah perempuan hamil dalam menerima program toksoid Tetanus selama kehamilan juga mengalami peningkatan (Baba-Ari, Eboreime and Hossain, 2018).…”

Perceptions of beneficiaries and health professionals regarding a conditional cash transfer program to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomized controlled study

“…CCT programs have improved the well-being of families in all countries where they have been implemented. Children and women are the first beneficiaries of theses cash transfers (6,18,19).…”

“…It has been shown that suboptimal pregnancy follow-up, defined as less than 80% or less than 50% of scheduled follow-up, is associated with a two-fold risk of severe maternal and neonatal morbidity (4,5). Several countries, mostly of low or medium income, have introduced economic incentives, hoping (among other things) to encourage women to consult during pregnancy (4,6) or to encourage families to have their young children followed by a doctor or sent to school (7). For the most part, this type of cash incentive program has been implemented in developing countries, particularly in Latin America with the Bolsa Familia Program in Brazil (7), Solidario in Chile (7) or the PROGRESA-Oportunidades program in Mexico (8.9).…”