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Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya

There is limited evidence on the cost and cost-effectiveness of cash transfer programmes to improve maternal and child health in Kenya and other sub-Saharan African countries. This article presents the economic evaluation results of the Afya trial, assessing the costs, cost-effectiveness and equity...

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Autores principales: Palmer, Tom, Batura, Neha, Skordis, Jolene, Stirrup, Oliver, Vanhuyse, Fedra, Copas, Andrew, Odhiambo, Aloyce, Ogendo, Nicholas, Dickin, Sarah, Mwaki, Alex, Haghparast-Bidgoli, Hassan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021150/
https://www.ncbi.nlm.nih.gov/pubmed/36962294
http://dx.doi.org/10.1371/journal.pgph.0000128
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author Palmer, Tom
Batura, Neha
Skordis, Jolene
Stirrup, Oliver
Vanhuyse, Fedra
Copas, Andrew
Odhiambo, Aloyce
Ogendo, Nicholas
Dickin, Sarah
Mwaki, Alex
Haghparast-Bidgoli, Hassan
author_facet Palmer, Tom
Batura, Neha
Skordis, Jolene
Stirrup, Oliver
Vanhuyse, Fedra
Copas, Andrew
Odhiambo, Aloyce
Ogendo, Nicholas
Dickin, Sarah
Mwaki, Alex
Haghparast-Bidgoli, Hassan
author_sort Palmer, Tom
collection PubMed
description There is limited evidence on the cost and cost-effectiveness of cash transfer programmes to improve maternal and child health in Kenya and other sub-Saharan African countries. This article presents the economic evaluation results of the Afya trial, assessing the costs, cost-effectiveness and equity impact of a demand-side financing intervention that promotes utilisation of maternal health services in rural Kenya. The cost of implementing the Afya intervention was estimated from a provider perspective. Cost data were collected prospectively from all implementing and non-implementing partners, and from health service providers. Cost-efficiency was analysed using cost-transfer ratios and cost per mother enrolled into the intervention. Cost-effectiveness was assessed as cost per additional eligible antenatal care visit as a result of the intervention, when compared with standard care. The equity impact of the intervention was also assessed using a multidimensional poverty index (MPI). Programme cost per mother enrolled was International (INT)$313 of which INT$ 92 consisted of direct transfer payments, suggesting a cost transfer ratio of 2.4. Direct healthcare utilisation costs reflected a small proportion of total provider costs, amounting to INT$ 21,756. The total provider cost of the Afya intervention was INT$808,942. The provider cost per additional eligible ANC visit was INT$1,035. This is substantially higher than estimated annual health expenditure per capita at the county level of $INT61. MPI estimates suggest around 27.4% of participant households were multidimensionally poor. MPI quintiles did not significantly modify the intervention effect, suggesting the impact of the intervention did not differ by socioeconomic status. Based on the available evidence, it is not possible to conclude whether the Afya intervention was cost-effective. A simple comparison with current health expenditure in Siaya county suggests that the intervention as implemented is likely to be unaffordable. Consideration needs to be given to strengthening the supply-side of the cash transfer intervention before replication or uptake at scale.
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spelling pubmed-100211502023-03-17 Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya Palmer, Tom Batura, Neha Skordis, Jolene Stirrup, Oliver Vanhuyse, Fedra Copas, Andrew Odhiambo, Aloyce Ogendo, Nicholas Dickin, Sarah Mwaki, Alex Haghparast-Bidgoli, Hassan PLOS Glob Public Health Research Article There is limited evidence on the cost and cost-effectiveness of cash transfer programmes to improve maternal and child health in Kenya and other sub-Saharan African countries. This article presents the economic evaluation results of the Afya trial, assessing the costs, cost-effectiveness and equity impact of a demand-side financing intervention that promotes utilisation of maternal health services in rural Kenya. The cost of implementing the Afya intervention was estimated from a provider perspective. Cost data were collected prospectively from all implementing and non-implementing partners, and from health service providers. Cost-efficiency was analysed using cost-transfer ratios and cost per mother enrolled into the intervention. Cost-effectiveness was assessed as cost per additional eligible antenatal care visit as a result of the intervention, when compared with standard care. The equity impact of the intervention was also assessed using a multidimensional poverty index (MPI). Programme cost per mother enrolled was International (INT)$313 of which INT$ 92 consisted of direct transfer payments, suggesting a cost transfer ratio of 2.4. Direct healthcare utilisation costs reflected a small proportion of total provider costs, amounting to INT$ 21,756. The total provider cost of the Afya intervention was INT$808,942. The provider cost per additional eligible ANC visit was INT$1,035. This is substantially higher than estimated annual health expenditure per capita at the county level of $INT61. MPI estimates suggest around 27.4% of participant households were multidimensionally poor. MPI quintiles did not significantly modify the intervention effect, suggesting the impact of the intervention did not differ by socioeconomic status. Based on the available evidence, it is not possible to conclude whether the Afya intervention was cost-effective. A simple comparison with current health expenditure in Siaya county suggests that the intervention as implemented is likely to be unaffordable. Consideration needs to be given to strengthening the supply-side of the cash transfer intervention before replication or uptake at scale. Public Library of Science 2022-03-07 /pmc/articles/PMC10021150/ /pubmed/36962294 http://dx.doi.org/10.1371/journal.pgph.0000128 Text en © 2022 Palmer et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Palmer, Tom
Batura, Neha
Skordis, Jolene
Stirrup, Oliver
Vanhuyse, Fedra
Copas, Andrew
Odhiambo, Aloyce
Ogendo, Nicholas
Dickin, Sarah
Mwaki, Alex
Haghparast-Bidgoli, Hassan
Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title_full Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title_fullStr Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title_full_unstemmed Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title_short Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
title_sort economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021150/
https://www.ncbi.nlm.nih.gov/pubmed/36962294
http://dx.doi.org/10.1371/journal.pgph.0000128
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