Results Data from 51 studies ( 15 more than previous review s ) and 22 cash transfer and voucher programmes  suggest that approaches tied to service use ( either via payment conditionalities or vouchers for selected services ) can increase use of antenatal care , use of a skilled attendant at birth and in the case of vouchers , postnatal care too .
The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care , and for vouchers for maternity care services and birth with a skilled birth attendant .
However , effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators .
There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes .
Background Cash transfers and vouchers are forms of ‘ dem and -side financing ’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years .
Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya
Objective To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements . Data sources Nairobi Urban Health and Demographic Surveillance System ( NUHDSS ) and two cross-sectional household surveys in Korogocho and Viw and ani informal settlements in 2004–05 and 2006–08 . Methods Odds of facility-based delivery were estimated before and after introduction of an output-based voucher . Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations , a non-voucher outpatient service . As part of NUHDSS , households in Korogocho and Viw and ani reported place of delivery and the presence of a skilled birth attendant ( 2003–10 ) and vaccination coverage ( 2003–09 ) . A detailed maternal and child health ( MCH ) tool was added to NUHDSS ( September 2006–10 ) . Prospect i ve enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006 . In addition to recording mother ’s place of delivery , NUHDSS-MCH recorded the use of the voucher . Findings There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch . Testing whether unrelated outpatient care also increased , a falsification exercise found no significant increase in immunizations for children 12–23 months of age in the same period . Although the proportion completing any antenatal care ( ANC ) visit remained above 95 % of all reported pregnancies and there was a significant increase in facility-based deliveries , the proportion of women completing 4 + ANC visits was significantly lower during the voucher programme . Conclusions A positive association was observed between vouchers and facility-based deliveries in Nairobi . Although there is a need for higher quality evidence and validation in future studies , this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved population
Results Data from 51 studies ( 15 more than previous review s ) and 22 cash transfer and voucher programmes  suggest that approaches tied to service use ( either via payment conditionalities or vouchers for selected services ) can increase use of antenatal care , use of a skilled attendant at birth and in the case of vouchers , postnatal care too .
The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care , and for vouchers for maternity care services and birth with a skilled birth attendant .
However , effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators .
There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes .
Background Cash transfers and vouchers are forms of ‘ dem and -side financing ’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years .