Perspectives of beneficiaries, health service providers, and community members on a maternal and child health conditional cash transfer pilot programme in Nigeria

Abstract

Summary Background Our paper presents experiences and perceptions of beneficiaries, health service providers, and community members about a conditional cash transfer (CCT) programme piloted in Nigeria from April 2013 to May 2015 to boost demand for maternal, newborn, and child health services. Methods We conducted a descriptive cross‐sectional retrospective study using both qualitative and quantitative methods. Personal interviews and focus group discussions (FGDs) were conducted between June and July 2015 for 314 CCT beneficiaries, 72 ward development committee (WDC) members, and 60 service providers (midwives, community health extension workers [CHEWs], and village health workers [VHWs]) including 29 officers‐in‐charge as key informants. Content analysis was applied to qualitative findings and grouped into themes of attitude, practices, CCT operations, payout, and perceived impact. Results Over 97% of beneficiaries affirmed that the cash incentive was very helpful and almost 70% opined that the free supply‐side services were the real benefit. Majority of service providers applauded the programme though, with complaints about the increased workload. Community members applauded the scheme, with mixed feelings over some operational processes. Conclusion Beneficiaries, service providers, and community members expressed deep satisfaction with the CCT programme and opined that antenatal care (ANC) and skilled birth delivery service utilization increased. Insights into some programmatic challenges are provided to enrich future CCT design and implementation.

Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study

“…Additionally, we found that CCT was a financial aid for establishing petty businesses and solving personal problems outside what it was intended for. Our study agrees with previous studies which averred that CCT was used in addressing poverty as beneficiaries indicated that they utilized the money in establishing businesses (40,48). This is not a surprise as 40.1% of the total population of Nigeria were categorized as being poor and has actual per capita expenditure less than N137,430($381) per year (49).…”

“…Our finding is in consistence with a systematic review on the impact of CCT on Maternal and Newborn Health in Kenya, Malawi, India, Nepal, Uruguay, Cambodia, and South Africa which showed a significant increase in the utilization of different MCH service (prenatal monitoring, ANCs, facility deliveries and, immunization) ( 22 , 28 , 39 ) among the target population. A similar study in Nigeria corroborated with our study showing a significant increase in more women attending four or more ANC visits, facility birth, and receiving two or more tetanus toxoid doses during pregnancy ( 28 , 40 ). In the context of other healthcare preventive and curative services, CCT had been previously reported to improve: HIV testing, care, and prevention ( 13 , 41 ); completion of tuberculosis treatment regimens ( 42 , 43 ); adherence to the hepatitis B vaccine ( 44 ) and; nutritional uptake ( 45 ).…”