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Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya

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  • Grépin, Karen A.
  • Habyarimana, James
  • Jack, William

Abstract

We conducted a randomized controlled experiment to test whether vouchers, cash transfers, and SMS messages were effective in boosting facility delivery rates among poor, pregnant women in rural Kenya. We find a strong effect of the full vouchers and the conditional cash transfers: 48% of women with access to both interventions delivered in a health facility, while only 36% of those with neither did. Amongst women who did not receive a cash transfer, we find that a small copayment dramatically reduced voucher effectiveness, suggesting a discontinuous impact of cost-sharing on the demand for health services. Both the unconditional cash transfer and the text messages had limited effect on the use of health services. Finally, we also find no evidence that a government policy to eliminate user fees increased demand for maternal health services.

Suggested Citation

  • Grépin, Karen A. & Habyarimana, James & Jack, William, 2019. "Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya," Journal of Health Economics, Elsevier, vol. 65(C), pages 15-30.
    • Handle: RePEc:eee:jhecon:v:65:y:2019:i:c:p:15-30
    DOI: 10.1016/j.jhealeco.2018.12.001
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    Cited by:

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    2. Cooper, Jan E. & Benmarhnia, Tarik & Koski, Alissa & King, Nicholas B., 2020. "Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries," Social Science & Medicine, Elsevier, vol. 247(C).
    3. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2024. "Selection and behavioral responses of health insurance subsidies in the long run: Evidence from a field experiment in Ghana," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 992-1032, May.
    4. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2021. "Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana," Papers 2105.00617, arXiv.org.
    5. Edward N. Okeke, 2021. "Money and my mind: Maternal cash transfers and mental health," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2879-2904, November.
    6. Hiroyuki Egami & Tomoya Matsumoto, 2020. "Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda," Sustainability, MDPI, vol. 12(9), pages 1-34, May.
    7. Lenel, Friederike & Priebe, Jan & Satriawan, Elan & Syamsulhakim, Ekki, 2022. "Can mHealth campaigns improve CCT outcomes? Experimental evidence from sms-nudges in Indonesia," Journal of Health Economics, Elsevier, vol. 86(C).
    8. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    9. Seohyun Lee & Abdul-jabiru Adam, 2021. "Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review," IJERPH, MDPI, vol. 19(1), pages 1-37, December.
    10. Paula von Haaren & Stefan Klonner, 2021. "Lessons learned? Intended and unintended effects of India's second‐generation maternal cash transfer scheme," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2468-2486, September.
    11. Mark Bigool, 2024. "Effects of free maternal healthcare on stunting in children under five years of age: Evidence from Ghana," Development Policy Review, Overseas Development Institute, vol. 42(4), July.
    12. von Haaren, Paula & Klonner, Stefan, 2020. "Maternal cash for better child health? The impacts of India’s IGMSY/PMMVY maternity benefit scheme," Working Papers 0689, University of Heidelberg, Department of Economics.

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    More about this item

    Keywords

    Maternal health; Global health; Kenya; Developing countries; Randomized controlled trial;
    All these keywords.

    JEL classification:

    • L10 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - General
    • D10 - Microeconomics - - Household Behavior - - - General
    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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