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Centre for Health Economics and Policy Analysis


Cash on delivery: do incentives work to boost maternal health?

10 Feb 2016

Rates of maternal, newborn and child mortality remain unacceptably high in the developing world. A CHEPA seminar on Wednesday Feb. 17 a looks at measures taken in Kenya to overcome barriers preventing women from delivering their babies in a health clinic.

In the seminar, entitled
Cash on delivery and other mobile maternal health incentives: evidence from a randomized trial in Kenya, Karen A. Grépin, assistant professor of global health policy at New York University, will discuss the results of a randomized study conducted in early 2013, when 1,600 pregnant women in rural Kenya received different demand side incentives via mobile phone to boost the utilization of maternal health services.

These were: maternal vouchers (full or partial subsidy), transportation subsidies (conditional or unconditional on clinic attendance), and SMS text reminders.

Partway into the implementation of the study, Kenya introduced a free maternity care policy that covered maternal health services for all women in the country. 
Researchers found a strong effect of the conditional transport subsidy on facility deliveries, especially when coupled with the maternity voucher: women with both interventions were 40 per cent more likely to deliver in a clinic or hospital than those with neither.  

The maternity voucher alone also increased utilization of maternal health services, but no evidence was found that either type of text message affected utilization of maternal care services.

On the demand side, by comparing women without health care vouchers who delivered before and after June 1st, the free care policy appeared to have little impact on demand for facility deliveries.

On the supply side, researchers found evidence to support the hypothesis that the free care policy coincided with a reduction in some dimensions of quality, particularly those that could be varied on a patient-by-patient basis.  

They felt that targeted demand side interventions were more likely to dramatically increase rates of facility delivery and be more effective than were policy levers, which were associated with a reduction in the quality of services provided.

Karen A. Grépin is an assistant professor of global health policy at New York University’s Robert F. Wagner’s Graduate School of Public Service. Her research focuses on priority setting in health systems, institutional factors affecting the demand and supply of health services, and the politics and effectiveness of development assistance for health. 

She has a PhD in Health Policy (economics) from Harvard University and an SM in Health Policy and Management from the Harvard School of Public Health.

The seminar will be held on Weds. Feb. 17 from 12:30 p.m. to 1:30 p.m. in Communications Research Lab (CRL) B119. All are welcome. The seminar will be available remotely for those unable to attend.

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