Results of a study from Honduras in this week's issue of THE LANCET show how direct cash payments from government to poor families improves the take-up of antenatal and infant health services.
Scaling-up of effective preventive interventions in child and maternal health is often restricted in developing countries by a lack of demand for health services from the local population. In Latin America, some governments have been trying to increase demand for health interventions by making direct payments to poor households contingent on them keeping up-to-date with preventive health services; however there has been very limited evidence to date showing that direct payments improve the take-up of these services.
Saul Morris (now at the UK Department for International Development) and colleagues studied households from 70 municipalities in Honduras with the highest rates of malnutrition. Around 5600 households were allocated at random to one of four groups: money to households; resources to local health teams combined with a community-based nutrition intervention; both packages; and neither.
Participants were followed up 2 years later and surveyed to record any changes in use of health services. The household-level intervention had a large impact (15–20% increase) in coverage of antenatal care and well-child check-ups. Childhood immunisation series could therefore be started more opportunely, and the coverage of growth monitoring was markedly increased. The transfer of resources to local health teams could not be implemented properly because of legal complications.
Dr Morris comments: "We feel confident that there is now convincing evidence that direct payments to households do increase the use and coverage of preventive health care interventions. If this outcome is to be translated into improved health status, it is essential that high quality preventive health care services be provided."
In an accompanying commentary (p 1996), Duff Gillespie (Johns Hopkins Bloomberg School of Public Health, USA) concludes: "Conditional cash transfer is not a magic bullet. Poor people are not likely to use poor preventive health services even if they are paid to do so. Like the other Latin American programmes, the Honduran programme uses a two-prong approach, upgrading the health infrastructure, the supply side, and increasing demand with conditional cash transfers. Monetary incentives can be the turbochargers of health systems and can significantly boost their productivity."
Contact: Dr Saul S Morris, EMAD, Department for International Development, 1 Palace Street, London SW1 5HE, UK; s-morris@dfid.gov.uk
Dr Duff Gillespie, Bill and Melinda Gates Institute for Reproductive Health and Population, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; dgillesp@jhsph.edu
Journal
The Lancet