Studies that documented improved care-seeking indicated the importance of adequate programme scope ( in terms of programme eligibility , size and timing of payments and voucher entitlements ) to address the issue of concern , concurrent investments in supply-side capacity to sustain and /or improve quality of care , and awareness generation using community-based workers , leaders and women ’s groups .
Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social , geographical and health systems factors as barriers to accessing care .
Background Dem and -side financing ( DSF ) interventions , including cash transfers and vouchers , have been introduced to promote maternal and newborn health in a range of low- and middle-income countries .
These interventions vary in design but have typically been used to increase health service utilisation by off setting some financial costs for users , or increasing household income and incentivising ‘ healthy behaviours ’ .
This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health .
Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor.
BACKGROUND Caesarean section rates are increasing in Mexico and Latin America . This study evaluates the impact of a large-scale , conditional cash transfer programme in Mexico on caesarean section rates . The programme provides cash transfers to participating low income , rural households in Mexico conditional on accepting health care and nutrition supplements . METHODS The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Using multivariate and instrumental variable analyses , we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting . Programme participation is measured by beneficiary status , programme months and cash transfers . RESULTS More than two-thirds of poor rural women delivered in a health facility . Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates ; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for > or=6 months before delivery . Beneficiaries had significantly higher caesarean delivery rates in social security facilities ( 24.0 compared with 5.6 % among non-beneficiaries ) and in other government facilities ( 19.3 compared with 9.5 % ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities . This effect appears to be driven by the increases in disposable income from the cash transfer . These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements
Studies that documented improved care-seeking indicated the importance of adequate programme scope ( in terms of programme eligibility , size and timing of payments and voucher entitlements ) to address the issue of concern , concurrent investments in supply-side capacity to sustain and /or improve quality of care , and awareness generation using community-based workers , leaders and women ’s groups .
Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social , geographical and health systems factors as barriers to accessing care .
Background Dem and -side financing ( DSF ) interventions , including cash transfers and vouchers , have been introduced to promote maternal and newborn health in a range of low- and middle-income countries .
These interventions vary in design but have typically been used to increase health service utilisation by off setting some financial costs for users , or increasing household income and incentivising ‘ healthy behaviours ’ .
This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health .