Financial Incentives and Maternal Health: Where Do We Go from Here?

Lindsay Morgan, Mary Ellen Stanton, Elizabeth S. Higgs, Robert L. Balster, Ben Bellows, Neal Brandes, Alison B. Comfort, Rena Eichler, Amanda Glassman, Laurel Hatt, Claudia M. Conlon, Marge Koblinsky

Abstract


Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives—performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers—summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

Key words: Healthcare-seeking behaviour; Health services research; Maternal health services, economics/utilization; Newborn health services; Motivation; Pregnancy; Programme evaluation


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