Design, coverage and utilisation of maternity conditional cash programmes in low- and middle-income countries: a scoping review.

Abstract

Introduction: Over the years, conditional cash transfers (CCTs) have become a popular tool to enhance demand for, and access to, essential healthcare services. While the immediate goal of CCTs is to improve the affordability of healthcare services, these are also being used to improve all health-seeking behaviour outcomes across countries. We examined how the design, operationalisation and facilitation of maternity benefits programmes have evolved, and the advantages and challenges that accompany in low- and middle-income country settings.

Methods: A scoping review was conducted across three major electronic databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane library database. We also reviewed grey literature and used the snowball search approach to review the websites of numerous public health organisations and repositories. Based on set inclusion criteria and protocols, two reviewers independently screened titles and abstracts. This was followed by detailed full-text screening. Disagreements, if any, were resolved by a third researcher.

Results: Of 235 articles identified, 65 met the inclusion criteria. These articles shed light on a wide variety of CCT design features, including benefit sizes, monitoring and compliance mechanisms, and periodicity of transfers, insights on eligibility criteria, conditionalities to be fulfilled to avail the benefits such as mandatory antenatal and postnatal checks, institutional delivery, immunisation etc. Challenges highlighted include poor awareness and low community participation and lack of agency among women in decisions about use of cash among demand-side constraints. Supply-side issues range from lack of role clarity and ownership among service providers, inefficient fund flow, and inadequate staff and infrastructure provision to tackle increased service utilisation.

Conclusion: CCTs have the potential to improve access to maternal and child health services, but need effective design and operational processes, which should be closely monitored. CCTs could also benefit from addressing inequities by including more women from vulnerable and lower socio-economic groups.