Program Impact Pathway Analysis Reveals Implementation Challenges that Limited the Incentive Value of Conditional Cash Transfers Aimed at Improving Maternal and Child Health Care Use in Mali.
Mali
children
conditional cash transfer
health service utilization
nutrition
process evaluation
program impact pathway
Journal
Current developments in nutrition
ISSN: 2475-2991
Titre abrégé: Curr Dev Nutr
Pays: United States
ID NLM: 101717957
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
21
03
2019
revised:
11
07
2019
accepted:
15
07
2019
entrez:
19
9
2019
pubmed:
19
9
2019
medline:
19
9
2019
Statut:
epublish
Résumé
The program "Santé Nutritionnelle à Assise Communautaire à Kayes" (SNACK) in Mali aimed to improve child linear growth through a set of interventions targeted to mothers and children during pregnancy and up to the child's second birthday. Distributions of cash to mothers and/or lipid-based nutrient supplement to children 6-23 mo of age were added to SNACK to increase attendance at community health centers (CHCs). The aim of this study, which was embedded in a cluster-randomized impact evaluation of the program, was to assess the incentive value of the cash in relation to CHC attendance. We used a mixed-methods approach. We collected quantitative data on cash receipt and CHC attendance in a midline survey of mother-child pairs ( FLWs' knowledge of the objective and implementation plan of the cash program component was limited. A challenging physical environment and insufficient cash available for each distribution were identified as causes of irregularities in cash distributions. Most mothers mentioned having to return several times to receive their cash. Child health was identified as the main motivation to attend CHCs and cash was described as an additional benefit. Implementation constraints related to remoteness and inaccessibility may have undermined the incentive value of the cash transfers in the SNACK program. Additional research is needed to identify interventions that not only incentivize mothers to participate but that can be implemented effectively and with high quality in challenging contexts such as rural areas of Mali.
Sections du résumé
BACKGROUND
BACKGROUND
The program "Santé Nutritionnelle à Assise Communautaire à Kayes" (SNACK) in Mali aimed to improve child linear growth through a set of interventions targeted to mothers and children during pregnancy and up to the child's second birthday. Distributions of cash to mothers and/or lipid-based nutrient supplement to children 6-23 mo of age were added to SNACK to increase attendance at community health centers (CHCs).
OBJECTIVES
OBJECTIVE
The aim of this study, which was embedded in a cluster-randomized impact evaluation of the program, was to assess the incentive value of the cash in relation to CHC attendance.
METHODS
METHODS
We used a mixed-methods approach. We collected quantitative data on cash receipt and CHC attendance in a midline survey of mother-child pairs (
RESULTS
RESULTS
FLWs' knowledge of the objective and implementation plan of the cash program component was limited. A challenging physical environment and insufficient cash available for each distribution were identified as causes of irregularities in cash distributions. Most mothers mentioned having to return several times to receive their cash. Child health was identified as the main motivation to attend CHCs and cash was described as an additional benefit.
CONCLUSION
CONCLUSIONS
Implementation constraints related to remoteness and inaccessibility may have undermined the incentive value of the cash transfers in the SNACK program. Additional research is needed to identify interventions that not only incentivize mothers to participate but that can be implemented effectively and with high quality in challenging contexts such as rural areas of Mali.
Identifiants
pubmed: 31528837
doi: 10.1093/cdn/nzz084
pii: nzz084
pmc: PMC6735791
doi:
Types de publication
Journal Article
Langues
eng
Pagination
nzz084Références
Implement Sci. 2007 Nov 30;2:40
pubmed: 18053122
Lancet. 2008 Mar 8;371(9615):828-37
pubmed: 18328930
Cochrane Database Syst Rev. 2009 Oct 07;(4):CD008137
pubmed: 19821444
Food Nutr Bull. 2012 Jun;33(2 Suppl):S6-26
pubmed: 22913105
Lancet. 2013 Aug 3;382(9890):452-477
pubmed: 23746776
Lancet. 2013 Aug 10;382(9891):536-51
pubmed: 23746780
Food Nutr Bull. 2013 Sep;34(3 Suppl):S195-211
pubmed: 24261077
Food Nutr Bull. 2013 Sep;34(3 Suppl):S212-25
pubmed: 24261078
BMC Public Health. 2013;13 Suppl 3:S30
pubmed: 24564520
Health Policy Plan. 2015 May;30(4):432-41
pubmed: 24816570
BMC Public Health. 2015 Apr 01;15:316
pubmed: 25879417
Food Nutr Bull. 2014 Sep;35(3):289-95
pubmed: 25902588
Health Policy Plan. 2016 Apr;31(3):293-301
pubmed: 26135364
Cochrane Database Syst Rev. 2015 Dec 15;(12):CD009916
pubmed: 26671418
Rev Panam Salud Publica. 2016 Aug;40(2):124-137
pubmed: 27982370
J Nutr. 2017 Jul;147(7):1418-1425
pubmed: 28566529
Cochrane Database Syst Rev. 2017 Nov 15;11:CD011135
pubmed: 29139110
PLoS One. 2017 Dec 11;12(12):e0188952
pubmed: 29228022
Matern Child Health J. 2018 Mar;22(3):409-418
pubmed: 29288407
Health Policy Plan. 2018 Jun 1;33(5):675-696
pubmed: 29762708
J Health Econ. 2019 May;65:15-30
pubmed: 30878794