Using Demand-Side Incentives in Chiapas to Improve Maternal and Neonatal Health

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: The poorest women in hard-to-reach areas in Chiapas, Mexico have substantial difficulties accessing quality maternal and neonatal health care services. Studies in the region have shown that transportation is one of the main barriers to access services due to its cost. Providing pregnant women transportation vouchers (TTV) to deliver in a safe environment could increase the demand for health services and save many lives.

Methodology: The TTV is being implemented by the state Health Ministry, taking advantage of their existing health delivery platforms, create demand for institutional births, combined with service delivery interventions financed by the Salud Mesoamerica-2015 Initiative. A randomized controlled trial of TTV was implemented as a proof-of-concept in 23 participating primary care regions serving hard-to-reach women. The trial involved three arms, where two different delivery mechanisms where tested for TTVs; voucher was either given directly to the pregnant women during prenatal care, or to a midwife for each pregnant woman under their care along with a small monetary incentive for every institutional birth. The third arm served as a control.

Results: After a year of implementation both treatment arms have shown promising evidence of a sizable effect on institutional deliveries; TTV for pregnant women showed a 25 percentage point (PP) increase, while TTV for midwives showed a 15 PP increase, even when at most half of eligible women received a voucher. Qualitative evidence has revealed the most salient barriers to maternal health care are: lack of access and availability of transportation, language, perceived low quality of obstetric care at facility level and cultural practices.

Conclusion: TTVs may provide a cost-effective intervention to scale-up institutional services for women in hard-to-reach areas, especially where cost of transportation is a key barrier. Results will contribute to technical and fiscal policy-decisions in Chiapas.