• No results found

Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries

N/A
N/A
Protected

Academic year: 2021

Share "Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries"

Copied!
21
0
0

Loading.... (view fulltext now)

Full text

(1)

12-2016

Safeguarding maternal and child health in South Africa by starting

Safeguarding maternal and child health in South Africa by starting

the Child Support Grant before birth: Design lessons from

the Child Support Grant before birth: Design lessons from

pregnancy support programmes in 27 countries

pregnancy support programmes in 27 countries

M. F. Chersich

Stanley Luchters

D. Blaauw

F. Scorgie

E. Kern

See next page for additional authors

Follow this and additional works at:

https://ecommons.aku.edu/eastafrica_fhs_mc_popul_health

(2)
(3)

Income poverty and inequality remain pervasive worldwide, leaving many households with insufficient resources to meet their needs. In South Africa (SA), one of the most inequitable countries in the world, the poorest 20% of the population consumes only 4% of the country’s goods and services, while the richest 20% takes 61%.[1] Pregnancy and

childbearing further marginalise vulnerable women and children by reducing income-generating potential and introducing a host of new financial needs. Only 14% of pregnant women in the poorest quartile are employed, either in the informal or the formal sector.[2]

Pregnancy and breastfeeding considerably increase the volume and variety of food a women needs.[3] Inadequate nutrition during

pregnancy results in adverse birth outcomes, suboptimal neonatal growth and development, and impaired cognitive development later in life.[4] Essentially, the nutritional status of the fetus in utero

has a marked effect on subsequent child health and life chances, as

well as intergenerational effects.[5] Also, during pregnancy women

incur substantial costs for accessing services, such as transport and childcare for existing children, while seeking healthcare.

A large number of countries, including SA, have recognised the importance of providing support for children living in impoverished households, and the extent and range of benefits accrued are well documented.[6] The SA Child Support Grant (CSG), which began in

1998, provides ZAR350 (USD26) per month for children from birth up to 18 years. Eligibility is based on a means test, and currently there are over 10 million beneficiaries.[6] Timing this support to begin only

once a child is born, however, limits its effectiveness and cannot undo the harms of maternal deprivation during pregnancy. Conversely, providing support to women during pregnancy would enable an improvement in maternal nutrition and overall wellbeing. The earlier in pregnancy such support begins, the more optimal placental

Safeguarding maternal and child health in South Africa

by starting the Child Support Grant before birth: Design

lessons from pregnancy support programmes in 27 countries

M F Chersich,1,2 MB BCh, PhD; S Luchters,3,4,5 MB BCh, MSc (Public Health), PhD; D Blaauw,1 MB BCh, FCPHM (SA);

F Scorgie,2 MA, PhD; E Kern,1 BA Hons, Dip Information Science; A van den Heever,6 MA (Economics); H Rees,2 MB BChir, MA, MRCGP;

E Peach,3 BMBS, MPH, MSES; S Kharadi,7 BSc Hons; S Fonn,8 MB BCh, PhD

1 Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 2 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 3 Burnet Institute, Melbourne, Australia

4 Department of Epidemiology and Preventive Medicine, Medicine, Nursing and Health Sciences, Monash University, Australia

5 International Centre for Reproductive Health, Department of Urogynaecology, Faculty of Medicine and Health Sciences, Ghent University,

Belgium

6 Wits School of Governance, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa 7 Independent consultant, Toronto, Canada

8 Gender and Health Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Corresponding author: M Chersich (mchersich@wrhi.ac.za)

Background. Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child

development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants.

Objectives. To review design and operational features of pregnancy support programmes, highlighting features that promote their

effectiveness and efficiency, and implications thereof for SA.

Methods. Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries. Results. Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also

longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support.

Conclusions. Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and

operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.

(4)

subsequent generations.[7]

There is compelling empirical evidence that pregnancy support programmes alleviate the vulnerability of pregnant women – and, by extension, of their fetuses – with consequent improvements in maternal and child health outcomes.[8] Randomised trials in Latin

America and South-East Asia have demonstrated that pregnancy grants can promote weight gain during pregnancy, reduce maternal anaemia, raise antenatal care (ANC) and skilled birth attendant (SBA) coverage, reduce maternal mortality, and prevent low-birth-weight births and infant mortality, among other benefits (see Table 1). Similarly, several SA studies have shown that among child

come in the very early nutrition window of childhood. In one modelling study, children who began receiving the CSG within the first year of life had a 0.45 higher height-for-age z-score than other children, and this was expected to translate into an average 5 - 7% higher monthly wage as adults.[9]

The effect of extending the existing social welfare system in SA to encompass pregnant women would depend on how well it is designed and implemented. Identifying lessons from experiences with pregnancy support programmes in other low- and middle-income countries (LMICs) could help inform the design of and optimise gains from a similar programme in SA, and indicate how best to build

Table 1. Summary of benefits of maternity and early childhood support

Benefit category Type of benefit Description of impact

Maternal nutrition

Maternal weight gain and anaemia

More women gain weight necessary for healthy pregnancy, but also some rise in maternal obesity noted in two studies.[10] Reduced maternal anaemia. Improved maternal nutrition can lower maternal anaemia by 39%.[10,11]

Gender relations Women’s position within household

Increases in women’s bargaining power and intra-household decision-making, and reduced domestic violence. Long-term support increased marriage rates by 4%.[12] Equity Targeting and impact on poor Successfully targeted poor in most instances. Impacts generally greater in poor than

other groups. Health service

utilisation ANC attendance Rise in ANC attendance in eight studies, ranging from 19% in a trial in Honduras [13] to 65% in Peru,[14] and a 4-fold increase in Bolivia.[15]

SBA coverage Rose 3.6-fold in Bangladesh,[16] and rose in four other countries. Also improved timeliness of access to services in childbirth.

Health services quality

Quality of care Low-quality health services limit the benefits gained by higher patient demand for services. However, more empowered, informed and proactive patients demanded higher-quality services, thus improving service quality.

Maternal health

and wellbeing Maternal mortality Grant reduced maternal mortality by 11% in Mexico,

[17] but voucher scheme did not.[18] Physical and mental stress Women more able to rest in late pregnancy, with reduced physical and mental stress. Child health Stillbirth rate Improved nutrition can reduce stillbirths by 45%.[19]

Birth weight Mexico trial showed 127 g rise in birth weight from the grant.[20] Reduction in low birth weight (<2 500 g) varied from 5% in Mexico[20] to 15% in Uruguay,[21] 0 - 30% in the USA and 40% in black recipients in the USA.[22] In Columbia, newborn weight rose in urban but not rural areas. Improved nutrition during pregnancy can reduce low birth weight by 16%.[23]

Premature and small-for-gestational-age babies

No effects on prematurity in Uruguay, but marked reductions in the USA. Also, with each 10% increase in duration of support in the USA, the risk of a full-term small-for-gestational-age baby dropped by 2.5%.[7] Improved nutrition in pregnancy can reduce the prevalence of small-for-gestational-age babies by 14 - 32%.[23]

Infant growth Infants in the intervention arm of the Mexico trial were 1.1 cm taller and had less childhood anaemia.[24] In the USA, infants of grant recipients were much more likely to be of normal weight and length, and 2-fold more likely to be perceived as having good health, than non-recipients.[25]

Newborn and infant survival USA grantees had a lower infant mortality rate, and infant mortality was 11% lower in Mexico. In India a grant lowered perinatal deaths by 3.7/1 000 and neonatal deaths by 2.3/1 000.[26] Improved maternal nutrition can reduce neonatal mortality by 38% and infant mortality by 22%.[23]

Child growth and development Offspring of women receiving a grant in Mexico had higher height at 24 - 68 months, fewer were stunted and fewer were overweight.[10] Grants increased childhood motor and

cognitive development, and receptive language abilities.[27] In Brazil, children from families who received a grant were 26% more likely to be of normal height and weight.[28] In SA, children beginning the CSG in infancy had a 0.45 higher height-for-age z-score than other children.[9]

Human capital and long-term development

SA research shows that height at 2 years is the best predictor of human capital, and that damage suffered in early life leads to permanent impairment and affects future generations.[4] Improving child nutrition during infancy and before 3 years can raise adult income by 46% in men.[29]

(5)

upon existing social support programmes. We conducted a systematic review of pregnancy support programmes in LMICs, examining their objectives, types of support provided and factors facilitating implementation, and then considered the implications of these findings for providing an integrated SA maternal and child support programme starting in pregnancy. The health and social impacts of pregnancy support were not reviewed in detail, as these have already been clearly demonstrated in multiple systematic reviews (Table 1).

Methods

The systematic review began with a scoping search of Medline (PubMed) using subject headings and thesaurus terms. The full search strategy and terms are provided in Appendix 1. In brief, electronic databases including Academic Search Complete, Psychology and Behavioural Sciences Collection, Educational Resources Information Centre and Global Health Library were searched in August 2012. Reference lists of included articles were examined to identify other eligible articles. We also searched the websites of relevant international organisations (the World Bank, Save the Children and the United Nations Development Programme) for additional ‘grey literature’ (print and electronic format documents that are not produced by commercial publishers).

To be included in the review, documents had to describe projects implemented in a LMIC that provided cash or vouchers (redeemable for services or commodities) for women or the households in which they lived during pregnancy or childbirth. Projects that only provided postpartum support were excluded. Cash or other support during pregnancy could be the only intervention, or form part of a suite of interventions. We included both state and non-governmental programmes, operational at a national or local level. Excluded were projects that: (i) had pro-natalist objectives (i.e. aimed specifically to increase fertility in the target population); (ii) provided occupational benefits as part of paid maternity leave for women in the formal sector; (iii) entailed only user-fee exemptions at health facilities for pregnant women; and (iv) provided support other than cash or vouchers, such as only nutritional supplements.

A single reviewer extracted data on: (i) the groups targeted and objectives of support; (ii) key design features, including the means of identifying target groups, the type and duration of support, and conditionalities; and (iii) practical experiences with implementation, including administrative challenges faced with eligibility screening, disbursement or verification of conditionalities being met. The outcomes and impact of pregnancy support were also extracted, but are only summarised here (Table 1) as they have been reviewed extensively elsewhere.[8]

The analysis focused on comparing the objectives and design of projects across settings and identifying the challenges encountered by projects with different design formats and implementation strategies. We also assessed programme changes over time, and what lessons could be derived from these changes. Finally, we discussed the implications of the overall findings for the SA social grant system.

Results

The search identified 5 822 documents, from which we located a total of 32 programmes across 27 countries (Table 2). Data were drawn from 57 articles eligible for the review. Only four had started before 2000, with a median onset of 2005. Eight were in sub-Saharan Africa.

Target groups and support objectives

Two main categories of support could be differentiated. The first targeted only pregnant women (n=12). These initiatives were mainly

found in South-East Asia (8/12), and primarily aimed to increase utilisation of public sector ANC, SBAs and postpartum care among poor women. Generally, the schemes did not specifically aim to encourage early ANC attendance, although in the Indira Gandhi Matriva Sahyog Yojana (IGMSY) (Table 2, row 5) women had to register their pregnancy before 4 months’ gestation to be eligible, and this indirectly incentivised early booking. In some of these programmes assistance was also framed more broadly as a strategy for improving the health and nutrition of pregnant and lactating mothers, for example to enable adequate rest during pregnancy and after delivery (India, row 3), and to encourage optimal infant feeding practices. Finally, a few programmes, mainly in India, conceptualised maternity support as a means of compensating women for their reduced income-earning potential during pregnancy. The Dr Muthulakshmi Maternity Assistance Scheme (DMMAS) programme in India, for example, specifically seeks to ‘assist poor women with medical expenses around childbirth and compensate them for loss of wages around this time’ (row 3).

The second group of programmes (n=20) targeted pregnant women among other groups, such as children and vulnerable families or households. Most of these programmes were located in Latin America and the Caribbean (12/20), and framed their objectives in much broader terms than the first category. Many were targeted primarily at reducing poverty and food insecurity, or the building of social equity or solidarity, rather than health per se. For some, the focus was mainly on addressing childhood poverty, as in Peru (row 30), where programmes aimed to use pregnancy support as a way to create improved social safety nets for children. In addition, several schemes had more long-term aspirations, such as breaking intergenerational poverty cycles (Brazil, row 15; El Salvador, row 16; Peru, row 30; Mexico, row 25), making investments in human capital (Brazil, row 15; Peru, row 30; Jamaica, row 24; Ethiopia, rows 17 and 18), or building social capital (Paraguay, row 29) and inclusivity (Panama, row 28).

Identifying target groups

Programmes adopted one of two strategies for selecting recipients, either targeting all women in selected poor areas, districts or states, or identifying individual poor women, regardless of where they lived. Two-stage processes were sometimes used, where municipal or district areas were selected first, followed by the identification of vulnerable households (Peru, row 30). Methods used to identify individuals varied widely, including the use of a short interview (India, row 3, Cambodia, row 2); tasking ANC staff with identifying eligible recipients, such as women with anaemia or slow weight gain during pregnancy; and home visits to estimate socioeconomic status, based on the characteristics of households. Countries that opted to target all women in an area cited the costs of screening as the rationale for their choice (Bangladesh, row 1; Nepal, row 8).

Several maternity grants were specifically configured to counter the concerns of politicians and popular opinion that a grant would incentivise pregnancy (especially among young women), or even discourage women from accessing abortion services. Features of such grants included restricting eligibility to a certain number of children (India, rows 4 and 5; Nepal, row 8), to women aged >19 years (India, rows 4 and 5) and to those with birth spacing of >2 years (Bangladesh, row 1), and providing a fixed fee per household rather than payments per child, thereby favouring small families (El Salvador, row 16). Others included a condition that recipients attend family planning services for 2 years after childbirth, or incorporated attending talks on contraception as conditionalities.

(6)

Ta bl e 2. D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d Pr og ra mmes p ro vi din g o nly p re gna nc y a nd chi ld bir th s up po rt , ta rge tin g p re gna nt w ome n o nly 1 Ba ng lad es h: M at er na l h ea lth dem an d side fin an cin g p ilo t [2006] [16,30-32] Ca sh (a p or tio n of w hic h wa s CCT), v ouc her s an d g ift b ox es A ll pr eg na nt w om en i n th e p oor est su bd ist ric ts elig ib le. ‘ U ni ver sa l ta rg et in g’ t o a vo id hig h admini stra tiv e b ur den of iden tif yin g p oo r fa mi lies. M ea ns t es tin g us ed in s om e si tes. To in cr ea se acces s t o sk ille d a tten da nce a t chi ld bir th a nd P N C ser vices, a nd en ha nce eq ui ty in u tili sa tio n of t hes e s er vices US D29 f or faci lit y b irt h; US D29 f or n ut rit io us f oo d; gif t b ox w or th US D7 (b ab y so ap , b ig t ow el, 2 s ets b ab y clo th es, b ot tle , H or lic ks m al t dr in k); v ouc her f or 1 P N C ch ec k-u p; a nd US D7 f or tra ns po rt f or 5 v isi ts Vo uc her s t o r ecei ve s ki lle d c ar e a t ho m e o r a t faci lit y, a nd un co ndi tio na l ca sh p ay m en ts f or t ra ns po rt a nd fo od . V ouc her s ini tia lly o nl y f or fir st a nd s eco nd b irt hs a nd t hos e wh o u se d FP t o ac hie ve 2-y ea r b irt h sp acin g (t o minimi se in cen tiv e t o co ncei ve). I n p rac tice , co ndi tio ns n ot enf or ce d. S om e p ay m en ts co ndi tio na l on g ivin g b irt h in faci lit y. Pu blic sys tem s u se d f or c ha nn el lin g fun din g ra th er t ha n es ta bli shin g an in dep en den t a gen cy . C os ts as so ci at ed w ith c hi ld bir th g iv en t o ei th er faci lit y o r S BA if de liv er y a t ho m e. W om en c an c ho os e f ro m accr edi te d p ro vider s. 2 Ca m bo di a: Tw o sc hem es: H ea lth Eq ui ty F un d A ssi sta nce [2005] an d V ouc her Sc hem e [2007] [33-35] Ca sh a nd vo uch ers Po or p re gn an t w om en; on ly p reg na nt w om en cla ssif ie d a s ‘ ver y p oo r’ or ‘ po or ’ g et f ul l o r pa rt ia l s up po rt. N GO sta ff in ter vie w w om en to det er min e e lig ib ili ty , usin g q ues tio nn air e, in dex s co res a nd elig ib ili ty cr iter ia. To im pr ov e acces s to s af e de liv er y f or po or w om en in t hr ee rura l h ea lth di str ic ts by in cr ea sin g u se o f SB A s a nd he al thc ar e ser vices. T o r ed uce m at er na l m or ta lit y H ea lth E qui ty F un d: C as h f or hos pi ta l f ees, t ra ns po rt cos ts t o faci lit y, f oo d a llo wa nce d ur in g hos pi ta lis at io n, a nd f un era l cos ts in e ven t o f de at h Vo uc her s ch em e: Fi ve co up on s fo r f re e s er vices a t h ea lth cen tre (3 AN C, 1 c hi ld bir th a nd 1 PN C v isi t) a nd t ra ns po rt cos ts fo r 5 t rips f ro m h om e t o faci lit y No ne Ca sh ad va nces g iv en t o co nt rac te d faci lit y t o p ay t ra ns po rt cos t o f vo uc her , u sin g p re def in ed p rice lis t. R eim bur sem en t a m oun t va ries by v ill ag e in t he c at chm en t a re a. Vo uc her s ch em e b ein g t es te d f ro m 2010, a lo ngside faci lit y accr edi ta tio n (s tra teg y t o im pr ov e faci lit y per fo rm an ce). 3 Indi a: Dr M ut hu la ks hmi M at er ni ty A ssi sta nce S ch em e (D MMA S) [1987] [36] Ca sh (C CT) Po or w om en i n infor m al ‘u nor ga ni se d’ se ct or a t c hi ld bi rt h. Ex cludes w om en in for m al se ct or or w ith hig h in co m e. E lig ib ili ty ta kes in to acco un t na tur e o f o cc up at io n, ho usin g, m ea ns o f tra ns po rt, s ea so na lit y of l ab our , w om en-he ade d fa mi lies a nd ab ili ty t o e duc at e chi ldr en. To a ssi st p oo r w om en w ith m edic al exp en ses a ro un d chi ld bir th a nd co m pen sa te t hem f or los s o f wa ges a ro un d thi s t im e To p ro m ot e r es t bef or e a nd a fter de liv er y To im pr ov e n ut rit io n an d ex clu siv e br ea stf ee din g ra tes US D133; p ay m en t in cr ea se d to US D226 in 2012 N on e ini tia lly , a lth oug h s pe cif ic al ly lin ke d w ith inf or m at io n p ro vi sio n on m at er na l n ut rit io n a nd br ea stf ee din g ad vice . I n 2012, co nv er te d in to a C CT , r eq uir in g AN C a nd c hi ld h ea lth c he ck-u ps. Or ig in al ly g iv en in s ev era l in sta lm en ts, b ut b ec am e o nce-o ff pa ym en t a t c hi ld bir th in 2009, t o sim plif y admini stra tio n. Con tin ue d ...

(7)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 4 Indi a: Jan an i Sura ks ha Y oj an a ‘Sa fe M ot her ho od Sc hem e’ ( JS Y), pr ev io us ly N at io na l M at er ni ty B en ef it Sc hem e (NMBS) [1996] 26,37-39] Ca sh (C CT) Po or w om en dur ing pr eg na nc y a nd a t chi ld bi rt h. S up por t ini tia lly o nl y f or w om en a ge d >19 ye ar s; f irs t 2 li ve bir th s; w om en w ith a g ov er nm en t-i ss ue be lo w-p ov er ty-lin e ca rd o r f ro m a lo w ca ste o r t rib e. P ar ity cr iter ia r em ov ed l at er . In 10 hig h-f oc us s ta tes, al l w om en e lig ib le. To r ed uce m at er na l an d n eo na ta l de at hs by in cen tiv isin g w om en o f lo w so cio eco no mic sta tu s t o g iv e b irt h in faci lit ies On ce-o nl y p ay m en t o f US D14, 8 - 12 w ee ks b ef or e c hi ld bir th. Ca sh s up po rt a fter t hir d AN C v isi t a nd a fter de liv er y in g ov er nm en t o r accr edi te d pr iva te faci lit y (±US D13.3 in urb an a nd ±US D15.6 in r ura l ar ea s). A ddi tio na l a m oun t gi ven if em er gen cy t ra ns po rt or CS r eq uir ed . A ddi tio na l am oun ts in 10 hig h-f oc us sta tes w ith lo w le ve ls o f faci lit y b irt hs. I ncr ea ses in am oun t o ver t im e, a nd b en ef it ext en de d t o h om e b irt hs. Su pp or t co ndi tio na l o n a tten din g 3 AN C v isi ts a nd , ini tia lly , o n h av in g an in sti tu tio na l de liv er y. C omm uni ty h ea lth w or ker s (A SH A s) iden tif y p reg na nt w om en an d h elp t hem g et t o a faci lit y, a nd to en ter t he p rog ra mm e. 5 Indi a: In dira Ga nd hi M at rit va Sa hy og Y oj an a (I GMS Y) (I ndira Ga nd hi M ot her s’ Su pp or t S ch em e) [2010] [40] Ca sh (C CT) Pr eg na nt a nd lac ta tin g wo m en w ithin 6 m on th s p os tp ar tum. On ly f or w om en a ge d ≥19 y ea rs, f or f irs t 2 liv e b irt hs, a nd u p t o 6 m on th s p os tp ar tum. G ov er nm en t em plo ye es no t e lig ib le. To im pr ov e h ea lth an d n ut rit ion of p reg na nt a nd lac ta tin g w om en, a nd infa nts b y p ro m ot in g ap pr op ria te c ar e a nd ser vice u tili sa tio n dur in g p reg na nc y, sa fe de liv er y a nd lac ta tio n To en co ura ge op tim al f ee din g prac tices, in cludin g ea rly a nd ex clu siv e br ea stf ee din g f or 6 m ont hs To co m pen sa te in pa rt f or in co m e los s bef or e a nd a fter chi ld bir th US D112 in 3 in sta lm en ts, fro m s eco nd t rim es ter un til 6 m on th s a fter c hi ld bir th M eet in g t he f ol lo w in g co ndi tio ns: Reg ist ra tio n o f p reg na nc y a t he al th faci lit y <4 m on th s o f pr eg na nc y; ≥1 AN C v isi t w ith iro n/f olic acid t ab lets a nd t et an us to xo id; ≥1 co un se llin g s es sio n; in sti tu tio na l de liv er y a nd e ar ly ini tia tio n o f b re as tfe edin g; reg ist ra tio n o f b irt h o f c hi ld; c hi ld imm uni sa tio ns a nd a tten da nce a t ≥4 g ro wt h m oni to rin g co un se llin g; ex clu siv e b re as tfe edin g f or 6 m on th s; in tro duc tio n o f cer tif ie d co m plem en ta ry f ee din g b y m ot her . No t s ta te d C on tin ue d ...

(8)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 6 Ke nya: Rep ro duc tiv e-H ea lth O ut put -Ba se d A id (RH-O BA) vo uc her p ilo t pr og ra mm e [2006] [41-44] Vo uch ers Pr eg na nt w om en b elo w po ver ty t hr es ho ld (th os e s co rin g lo w on a 14-i tem p ov er ty gradin g t oo l m ea sur in g fo od s ec ur ity , ho us eh old a ss ets a nd acces s t o h ea lth ca re). Ta rg et in g w om en in inf or m al s et tlem en ts in se vera l ci ties a nd r ura l di str ic ts. To in cr ea se faci lit y bir th s a m on g p oo r w om en in f or m al set tlem en ts, a nd t hu s re duce m at er na l a nd ne on at al m or ta lit y To im pr ov e acces s to h ea lth s er vices fo r p oo r w om en thr oug h in cen tiv es fo r in cr ea se d dem an d an d im pr ov ed s er vice pr ov isi on Vo uc her s p ur ch as ed f or US D2.50. V ouc her f or 4 AN C vi sits, a faci lit y-b as ed de liv er y in cludin g CS if n eces sa ry , tre at m en t o f m at er na l a nd ne on at al co m plic at io ns, a nd PNC . No t s ta te d Elig ib le w om en b uy v ouc her s; faci lit ies r eim bur se US D12.50 f or clien ts co m plet in g AN C v isi ts, US D50 f or n or m al de liv er y a nd US D250 f or a CS. A ddi tio na l co m plic at io ns a lso r eim bur se d. Pr ov ider s accr edi te d. F un de d by in ter na tio na l do no rs a nd go ver nm en t o f K en ya. 7 M on go lia: So ci al a ssi sta nce m at er ni ty b en ef its [2005] [45] Ca sh Pr eg na nt w om en. Pr ov ide d t o a ll w om en af ter 196 d ays o f pr eg na nc y w ho a re in elig ib le f or s oci al in sura nce (h av e no t p aid in sura nce co nt rib ut io ns). W om en r ecei vin g so ci al in sura nce g et m at er ni ty b en ef its in sep ara te p rog ra mm e. Infa nt b en ef it o nl y fo r v er y p oo r fa mi lies (unr el at ed t o t w in ben ef it). No t s ta te d Sh or t-t er m b en ef it s et a t minim um wa ge le ve l, g iv en fo r 4 m on th s. A lso ‘ tw in ben ef it’, a o nce- o nl y p ay m en t to p ar en ts o f t w in s. No ne No t s ta te d C on tin ue d ...

(9)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 8 Ne pa l: S afe D eli ver y I ncen tiv e Pr og ra mm e (S D IP) [2005] 46-48] Ca sh (C CT) Pr eg na nt w om en na tio nw ide . I ni tiall y, w om en e lig ib le o nl y if t he y h ad h ad <2 liv in g c hi ldr en (t o av oid p ot en tia l r isk o f pr og ra mm e in cr ea sin g fer tili ty) o r w ith a n obs tet ric co m plic at io n on a p res pe cif ie d li st. In 2007, e lig ib ili ty cr iter ia r em ov ed a nd al l w om en e lig ib le. To r ed uce m at er na l m or ta lit y a nd m or bi dit y To ra ise S BA co vera ge , addr es sin g dem an d-side b ar rier s M or e b ro ad ly, t o co nt rib ut e t owa rd s po ver ty r ed uc tio n b y pr ev en tin g m or ta lit y an d di sa bi lit y, a nd re ducin g cos ts o f de liv er y c ar e A m oun t va ries acco rdin g to acces sib ili ty : US D7.8 in pl ain s di str ic ts, US D15.6 in hi ll di str ic ts a nd US D23.4 in m oun ta in di str ic ts. Acco m pa nie d b y in cen tiv es to acces s p ro vider a nd f re e de liv er y c ar e if w om en co m e fro m 25 le as t de ve lo pe d di str ic ts. D eli ver y in h ea lth faci lit y H ea lth cen tres di sb ur se c as h. 9 Pa kis ta n: Jh an g an d D era G hazi K ha n Ci ty , Pun ja b, Jh an g vo uc her s ch em e [2008] [49,50] Vo uc her s a nd ca sh Pr eg na nt w om en in p oor h ou se hol ds (p oo res t t w o q uin tiles), iden tif ie d b y o ut re ac h w or ker s, u sin g s co re sh eets o r s pe cif ic cr iter ia. To in cr ea se u tili sa tio n of AN C, P N C, in sti tu tio na l de liv er y an d fa mi ly p la nnin g am on g p oor w om en Vo uc her b oo klets va lue d a t US D48 b ut s old f or US D1.3, co ver in g 3 AN C v isi ts, in sti tu tio na l de liv er y, a P N C vi sit a nd p os tn at al FP v isi t. W om en w er e g iv en c as h f or tra ns po rt in Jh an g: US D1.2 AN C, US D6.0 n or m al de liv er y, US D14.3 CS, US D1.8 FP v isi t, lo wer a m oun ts in o th er si te . No ne Pr ov ider s r eim bur se d b y p ro je ct. 10 U ga nd a: Rep ro duc tiv e H ea lth V ouc her Pr oj ec t (RHVP), ‘H ea lth y B ab y’ vo uc her s [2008] [44,51] Vo uch ers Po or p re gn an t w om en. To ol s in cludin g lo ca l m ar ker s o f p ov er ty o r vu ln era bi lit y u se d t o scr een f or p ov er ty . To in cr ea se p oo r w om en ’s acces s t o qu ali ty h ea lth ca re ser vices Vo uc her s s old f or US D1.5, to b e u se d a t p riva te o r n on-pr of it p ro vider s f or AN C, chi ld bir th a nd P N C v isi ts f or co m plic at io ns, a s w el l a s f or tra ns po rt. No ne M ar ie S to pes ac ts a s a v ouc her m an ag em en t a gen cy , a nd s el ls vo uc her s. V ouc her s c an b e re de em ed a t m ul tip le p ro vider s. Fun de d b y in ter na tio na l do no rs a nd go ver nm en t o f U ga nd a. 11 U ga nd a: Sa vin g M ot her s, G iv in g Lif e (S M GL) [2012] [52] Vo uc her s a nd bir th h am per s Pr eg na nt w om en i n rur al di str ict s To r ed uce m at er na l m or ta lit y Vo uc her s f or t ra ns po rt a nd acces s t o p riva te faci lit ies. Bir th h am per s f or w om en. No ne Vo uc her s di str ib ut ed b y p riva te faci lit ies. F un de d b y in ter na tio na l don or s. C on tin ue d ...

(10)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 12 Zamb ia : Sa vin g M ot her s, G iv in g Lif e (S M GL) [2012] [52] Vo uc her s a nd bir th h am per s Pr eg na nt w om en i n rur al di str ict s To r ed uce m at er na l m or ta lit y Vo uc her s f or t ra ns po rt a nd acces s t o p riva te faci lit ies. Bir th h am per s f or w om en. No ne Vo uc her s di str ib ut ed b y p riva te faci lit ies. F un de d b y in ter na tio na l don or s. Pr og ra mmes p ro vi din g p re gna nc y a nd chi ld bir th s up po rt , w he re p re gna nt w ome n a re ta rge te d a lo ng w ith o the r g ro ups 13 A rge nt ina: Pr og ra m a Fa mi lia s (P rog ra mm e Fa mi lies f or S oci al In clu sio n) [2002] [53] Ca sh (C CT) Pr eg na nt w om en, ch ild ren u nd er 18, or d isa bl ed. Ta rg ets fa mi lies w ith >1 c hi ld . No t s ta te d US D19 - 38 p er m on th Bim on th ly AN C v isi ts; co m pli an ce w ith imm uni sa tio n s ch ed ule; sc ho ol enr olm en t a nd r egu la r at te nd anc e Pa id t o m ot her t hr oug h de bi t c ar ds. 14 Bo liv ia: ‘Ju an a Azur du y’ s tip en d [2009] [15,54] Ca sh (C CT) Pr eg na nt w om en, ne wb or ns a nd i nf an ts. Fa mi lies w ith lo w in co m e e lig ib le w ith co ndi tio ns; fa mi lies in ext rem e p ov er ty elig ib le w ith n o co ndi tio ns. To r ed uce m at er na l m or ta lit y a nd ext rem e p ov er ty CCT p ay m en ts t o p reg na nt w om en t ot al lin g US D260, in in sta lm en ts o ver 33 m on th s At ten din g r egu la r AN C a nd P N C ch ec k-u ps un til c hi ld i s 2 y ea rs o ld an d h av in g S BA p res en t d ur in g bir th. A lso ≥85% o f m on th ly sc ho ol h our s f or c hi ldr en a ge d 7 - 17 y ea rs. N o lo ngs ta ndin g g ra nt admini stra tio n s tr uc tur e a va ila ble in co un tr y. 15 Br azi l: Bol sa Fa mi lia pr og ra mm e (F ami ly F un d) – in co rp ora te d t he pr ev io us B ol sa A lim en taç ão (N ut rit ion St ip en d) [2004] [28,55,56] Ca sh (C CT) Po or f am ili es; f am ili es w ith a p re gn an t o r la ct at in g w om an; fa m ili es w ith a ch ild/c hi ld ren a ge d 0 - 17 y ea rs. S om e ge og ra phic al t ar get in g. Fa mi lies a re m ea ns tes te d a nd a n at io na l reg ist er i s m ain ta in ed . To mi tiga te p ov er ty by m ak in g lo ng-ter m in ves tm en ts in hum an c ap ita l a nd th us in ter ru pt in g in ter gen era tio na l po ver ty c yc les To co m ba t h un ger an d p ro m ot e f oo d an d n ut rit ion se cu rit y To p ro m ot e acces s t o he al th, e duc at io n a nd so ci al s er vices Ca sh p ay m en t t hr oug h de bi t ca rd . A m oun t dep en ds o n deg re e o f p ov er ty a nd fa mi ly co m posi tio n: US D6.25 - 18.70 per h ou se ho ld e ac h m on th. Rep res en ts ±0.5% o f GD P. At ten din g AN C a nd P N C v isi ts; pa rt ici pa tio n in e duc at io na l h ea lth an d n ut rit io n s emin ar s o ffer ed b y lo ca l h ea lth t ea m s; vaccin at io ns f or pr eg na nt a nd b re as tfe edin g w om en an d c hi ldr en a ge d <7 y ea rs; at ten da nce a t s ch oo l f or ≥85% o f m on th ly s ch oo l h our s f or c hi ldr en ag ed 7 - 17 y ea rs. Admini stra tiv e cos t 4% o f pr og ra mm e b udg et. L ar ge ly t he res po nsi bi lit y o f fa mi lies t o en sur e co ndi tio ns a re m et. C on tin ue d ...

(11)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 16 El S alvad or : C om unid ades So lid ar ia s R ura les (S up po rt in g R ura l C omm uni ties), fo rm er ly R ed So lid ar ia (S olid ar ity N et w or k) [2005] [56-61] Ca sh (C CT) Fa m ili es w ith p re gn an t wo m en o r c hi ld ren age d u nd er 15 ye ars . G eog ra phic al ta rg et in g o f p oo res t 100 m unici pa lit ies  – su pp or t o nl y p ro vide d to fa mi lies in ext rem e po ver ty w ithin t hes e m unici pa lit ies. I n rura l a re as, cen su ses ca rr ie d o ut in e ac h m unici pa lit y t o iden tif y elig ib le r eci pien ts. I n urb an a re as, s ele ct io n by p ro xy m ea ns t es tin g. To a lle vi at e p ov er ty , w ith a f oc us o n r ura l ar ea s, a nd b re ak in g in ter gen era tio na l ef fe cts o f p ov er ty To a ssi st ext rem ely po or fa mi lies thr oug h s ho rt-t er m im pr ov em en ts in M CH, n ut rit io n, ed uc at io n, wa ter a nd sa ni ta tio n, e le ct rici ty an d r oad s Fix ed f ee p er fa mi ly ch os en t o fa vo ur sm al ler fa mi lies, ow in g t o f ea rs o f fer tili ty in cen tiv es Ini tia lly a m axim um US D20 per fa mi ly p er m on th Re ci pien ts sig n a gr eem en t (c al le d ‘co-r es po nsi bi lit ies ’) t o u se c as h fo r f oo d. S up po rt co ndi tio na l o n pr eg na nt w om en a tten din g a ll AN C v isi ts, r eg ist er in g c hi ldr en a t he al th ca re faci lit ies, vaccin at io n an d c hi ld h ea lth m oni to rin g pr og ra mm e. I n p rac tice co ndi tio ns no t m oni to re d. F un ds f or 3 y ea rs, th en e lig ib ili ty r e-e va lu at ed . Ini tia lly a b im on th ly p ay m en t, us ua lly t o m ot her , f ro m m unici pa lit y m ain s qu ar e. M or e re cen tly , f or fa mi lies w ith c hi ldr en ag ed <5 y ea rs o r p reg na nt w om en, a h ea lth v ouc her g iv en a s m on th ly ca sh t ra nsf er o f US D15 t ha t t he y c an ex ch an ge f or s er vices r ecei ve d a t t he he al th faci lit y. 17 Ethi op ia: M ek et Li vel iho od s D ev elo pm en t Pr oj ec t [2003] [62] Ca sh Po or est h ou se hol ds in e ac h co mm uni ty , fo llo w in g es ta bli sh ed prac tice in E thio pi a, w her e e lig ib le p eo ple ar e iden tif ie d t hr oug h th e lo ca l P ea sa nt A ss oci at io ns, w hic h as ses s li ves to ck ow ner shi p, l an d acces s an d p er fo rm an ce in pr ev io us h ar ves t. To h elp vu ln era ble ho us eho ld s w ith ‘es sen tia l f oo d exp en di tur e’ in dif fic ul t y ea rs, a nd to in ves t in a ss ets in bet ter y ea rs To b ridg e ga p b et we en ‘w elfa ris t’ a nd ‘de ve lo pm en t’ g oa ls To co nt rib ut e t o di ver sif ica tio n o f liv eli ho od o pt io ns, en ha nce co mm uni ty-lev el a ss ets, a nd stim ul at e r ura l ec on om y Ab ou t US D3.50 p er p er so n per m on th, va ry in g s ea so na lly . Ca sh a m oun t in cr ea ses w ith ho us eh old size , e .g . a 5-p er so n ho us eh old r ecei ves US D17.50. Th os e a ble t o w or k h av e t o w or k fo r c as h. Th os e w ho c ann ot o r sh ou ld n ot w or k a re e lig ib le f or th e un co ndi tio na l c as h t ra nsf er (p reg na nt/l ac ta tin g m ot her s, o lder pe op le, c hi ldr en, a nd t hos e w ith di sa bi lit ies). No t s ta te d C on tin ue d ...

(12)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 18 Ethi op ia: Pr od uc tiv e Sa fet y N et P rog ra mm e (PS NP) [2005] [62] Ca sh, v ouc her s, an d c as h-f or -w ork sc he me Pr eg na nt a nd lac ta tin g wo m en, a nd o th er gr ou ps i n a re as w ith fo od i ns ecu rity as w el l a s e co no mic al ly ac tiv e ‘m idd le poo r’ ho us eh old s. E lig ib ili ty as ses se d u sin g exi stin g admini stra tiv e an d co mm uni ty inf or m at io n s our ces. To r ed uce p ov er ty To a ssi st t he ‘pr odu ct iv e p oor’ ‘D ev elo pm en t’ ob je ct iv es ra th er t ha n ‘w elfa ris t’ s af et y n ets Su pp or t f or 5 y ea rs, a fter w hic h r eci pien ts a re exp ec te d to ‘ grad ua te’ o ut o f p ov er ty an d dep en den ce o n t ra nsf er s. Av era ge US D17 p er c ap ita/ ye ar p lu s f oo d – t ot al va lue ca n va ry s ubs ta nt ia lly . Ini tia lly s up po rt wa s lin ke d t o w or k, b ut co ndi tio n r em ov ed a s ef fe cts o f w or k o n w om en ’s h ea lth an d ex clu siv e b re as tfe edin g w er e re cog ni se d. D on or f un de d 19 Ec uad or : Pr og ra m a D esn ut rició n Zer o (Z er o M al nut rit ion Pr og ra mm e) [2010] [54,63,64] Ca sh (C CT) Pr eg nan t an d po stp ar tu m w om en, in fa nts. Ta rg ets p ar ish es w ith hig h m aln ut rit io n. On ly h ou se ho ld s w ith p reg na nt o r br ea stf ee din g w om an or w ith infa nt e lig ib le. Re ci pien ts m us t pr ov e t he y h av e liv ed ≥6 m on th s in a lo ca l co mm uni ty pa rt ici pa tin g in t he pr og ra mm e, ex cep t in Q ui to a nd G ua yaq ui l ci ties, w her e t he y m us t b e e lig ib le t o re cei ve t he H um an D ev elo pm en t V ouc her . To e limin at e f et al a nd infa nt m aln ut rit io n, an d im pr ov e at ten da nce a t an ten at al a nd infa nt ca re U p t o US D110, w ith US D10 fo r e ac h AN C v isi t (m axim um 5 v isi ts) a nd US D60 f or g iv in g bir th a t a h ea lth cen tre a nd at ten din g P N C a nd c hi ld vi sits in f irs t y ea r (m axim um 6 v isi ts). At ten din g a n e duc at io n a nd sen sit isa tio n p rog ra mm e f or m ot her s, w her e t he y le ar n ab ou t n ut rit io n a nd c ar e d ur in g pr eg na nc y a nd f or infa nts No t s ta te d C on tin ue d ...

(13)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 20 G ua te ma la: Mi Fa mi lia P rog res a (M y F ami ly Pr og res ses) [2008] [56,65] Ca sh (C CT) Po or est h ou se hol ds w ith in p oor est m un ici pa lit ies, w ith a p re gn an t w om an o r ch ild a ge d 0 - 6 y ea rs. G eog ra phic al t ar get in g of m unici pa lit ies w ith hig h ra tes o f ext rem e po ver ty , a nd p ro xy m ea ns t es tin g. To a lle vi at e p ov er ty US D18.4 l um p s um. Sa m e am oun t f or c hi ldr en a ge d 6 - 15 y ea rs w ho r em ain in sch oo l. At ten da nce a t s ch ed ule d c linic ch ec k-u ps f or p reg na nt w om en an d c hi ldr en a ge d 0  - 16 y ea rs, an d ≥90% s ch oo l a tten da nce . At ten da nce a t t ra inin g a nd ca paci ty b ui ldin g s es sio ns f or w om en o n h ea lth a nd n ut rit io n. H ou se ho ld s sig n ‘ co-r es po nsi bi lit y’ ag re em en t w ith a ut ho rit ies. C on cer ns a bo ut co rr up tio n in pr ojec t 21 H ond ur as: Pr og ra m a de A sig nació n Fa mi lia r P RAF II (F ami ly G ra nts Pr og ra mm e) [13,56,66] [P RAF b ega n 1990, b ec am e PR AF II in 2000] Vo uch ers Pr eg nan t an d br ea stfe ed in g w om en an d ext rem ely p oo r fa m ili es w ith m in or s age d 0 - 15 y ea rs. A ll ho us eh old s in t he 130 m os t vu ln era ble m unici pa lit ies in t er m s of m aln ut rit io n a nd lo w fa mi ly in co m e (a s re co rde d in cen su s) ar e e lig ib le. P reg na nt w om en m us t p ro vide pr oof of pr eg na nc y. To in cr ea se dem an d fo r p re ven tiv e he alt hc ar e f or pr eg na nt w om en, ne w mo the rs a nd chi ldr en a ge d <3 ye ar s To co m plem en t in co m e o f p oo r To r ed uce f oo d in se cur ity a nd al le vi at e m aln ut rit io n dur in g e co no mic ad ju stm en t Va lue o f v ouc her m ar ket ra te f or 1 d ay a gr ic ul tura l la bo ur d ur in g co ffe e h ar ves t. Exc ha nge ab le fo r c as h thr oug ho ut co un tr y. W om en re cei ve US D4.30 p er m on th of p reg na nc y o r w ith c hi ld un der 3. F ami ly s ubsidies ab ou t US D20/m on th p er fa mi ly a nd US D20 e duc at io n su bsid y, r ega rd les s o f n um ber of e lig ib le c hi ldr en. Vo uc her s t o c hi ldr en a ge d 6 - 12 y ea rs co ndi tio na l o n s ch oo l at ten da nce (m ax. 2 r eci pien ts p er ho us e). A tten da nce a t 5 AN C vi sits, P N C w ithin 10 d ays o f chi ld bir th, a nd c hi ld s er vices. I n prac tice , v ouc her s n ot w ith he ld f or no n-co m pli an ce . Pa id b ia nn ua lly t o m ot her thr oug h g ov er nm en t-o w ne d b an k (B anR ura l). A dmini stra tiv e cos t 5% of p rog ra mm e b udg et. 22 Indi a: Sa m bh av (‘I t i s p os sib le’) [2006] [67] Vo uch ers Pr eg na nt w om en a nd wo m en o f r ep rod uc tive age, as w el l a s be lo w-po ver ty l in e h ou se ho ld s an d s lu m r es id en ts in no rt her n I ndi a (t hr ee pr io rit y s ta tes: U tta r Prades h, U tta ra kh an d, an d J har kh an d) To in cr ea se acces s t o hig h-q ua lit y p riva te se ct or s er vices Vo uc her s co ver ra ng e o f AN C, chi ld bir th, P N C, n eo na ta l a nd fa mi ly p la nnin g s er vices No ne Ch oice o f accr edi te d p riva te pr ov ider s. C omm uni ty w or ker s (s uc h a s A SH A s) iden tif y p oo r ho us eh old s, di str ib ut e v ouc her s an d inf or m at io n. F un de d b y in ter na tio na l do no rs a nd s ta te go ver nm en t. C on tin ue d ...

(14)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 23 Ind ones ia: Pr og ra m Ke lu ar ga H ara pa n (H op ef ul F ami ly Pr og ra mm e) [2007] [56,68] Ca sh Pr eg na nt o r l ac ta tin g wo m en, c hi ld ren a ge d 0 - 18 y ea rs i n t he p oo re st hou se hol ds . P ro xy m ea ns t es tin g. To a lle vi at e p ov er ty To r ed uce m at er na l an d infa nt m or ta lit y Bet w een US D50 a nd US D184 fo r u p t o 6 y ea rs, dep en din g on h ou se ho ld co m posi tio n. Re ci pien ts a lso a ut om at ic al ly elig ib le f or A sk esK in (h ea lth in sura nce f or t he p oo r) a nd Ba nt ua n O per sio na l S ek ol ah (s ch oo l f ee wa iv er a nd tra ns po rt at io n a ssi sta nce) pr og ra mm es. Pr eg na nt a nd l ac ta tin g w om en at ten d AN C a nd P N C, acco rdin g to D ep ar tm en t o f H ea lth p ro to co ls. Chi ldr en a ge d 0 - 6 y ea rs a tten d clinic. C hi ldr en a ge d 7 - 15 y ea rs enr ol a nd a tten d ≥85% o f s ch oo l da ys. C hi ldr en a ge d 15  - 18 w ho ha ve n ot co m plet ed 9 y ea rs o f ba sic e duc at io n enr ol un til t he y co m plet e 9 y ea rs. Ca sh p aid t hr oug h lo ca l p os t o ffices dir ec tly t o m ot her o r w om an c ar in g fo r c hi ldr en in t hr ee in sta lm en ts per y ea r. 24 Ja ma ic a: Pr og ra mm e o f Ad va ncem en t thr oug h H ea lth an d E duc at io n (P ATH) [2001] [56,69] Ca sh Po or pr eg na nt or la ct at in g m ot her s, a nd ot her g ro up s s uc h as eld er ly a nd d isa bl ed. Pr oxy m ea ns t es tin g, w ith s ev era l va ria bles. To p ro vide a m ea nin gf ul le ve l o f ben ef it v ia a cos t-ef ficien t a nd acces sib le de liv er y sys tem, w ith ben ef its lin ke d t o desira ble b eh av io ura l ch an ges t ha t p ro m ot e in ves tm en t in h um an ca pi tal , e sp ec iall y chi ldr en Ap pr oxim at ely US D9 p er elig ib le h ou se ho ld m em ber , no fa mi ly c ap Ini tia lly co ndi tio na l o n a tten da nce at c linics, co ndi tio na lit y di sco nt in ue d s ho rt ly a fter pr og ra mm e l aun ch. Pr og ra mm e co ns olid at ed exi stin g ca sh a nd in-k in d t ra nsf er pr og ra mm es, w ith im pr ov ed ta rge ting . 25 M exi co: Pr og res a (P rog res s), ren am ed O po rt unid ades (O pp or tuni ties) in 2001 [1997] [10,11,20,70-73] Ca sh (C CT), fo od an d ed uc at io na l ben ef its Tra nsf er s ini tia lly on ly t o poo r r ur al hou se hol ds , exp an de d to u rb an ar ea s sin ce 2001. A m oun t gi ven dep en ds o n dem og ra phic s tr uc tur e of fa mi ly. M ea ns t es tin g an d g eog ra phic al ta rg et in g t o r eac h t he po or es t 20% o f t he rura l p op ul at io n. To t ar get p ov er ty by a lle vi at in g imm edi at e s uf fer in g an d b re ak in g t he in ter gen era tio na l tra nsmi ssio n o f po ver ty b y in ducin g pa ren ts t o in ves t in c hi ldr en ’s de ve lo pm en t H ea lth b en ef its o f US D17 per h ou se ho ld p er m on th; fo rt ifie d f oo d g iv en t o pr eg na nt a nd l ac ta tin g w om en; e duc at io na l b en ef its to c hi ldr en, dep en din g o n grade a t s ch oo l. 0.3% o f GD P sp en t o n p rog ra mm e. At ten da nce a t 5 AN C c he ck-u ps, nu tr itio na l s up plem en ta tio n, ed uc at io na l p rog ra mm e o n h ea lth an d n ut rit io n, b irt h a tten da nce , 2 PN C c he ck-u ps Pa id t o m ot her ’s s av in gs acco un t bim on th ly. C los e m oni to rin g o f co ndi tio ns, cos tin g a n es tim at ed 18% o f t ot al b udg et. C on tin ue d ...

(15)

Ta bl e 2. (c on tin ue d) D es ig n f ea tur es o f p ro gr ammes p ro vi din g ma te rni ty a nd e arly chi ld s up po rt in LMI Cs Be ne fici ar y s el ec tio n a nd s up po rt o bje ct iv es Ty pe of su pp or t Ro w no. C ou nt ry : pr og ra mme na me [y ea r b eg an] Fo rm o f su pp or t Ta rge t g ro ups (i ta lics) and e lig ib ili ty cri te ri a Ke y o bje ct iv es o f su pp or t p ro gr amme Va lu e a nd me tho d o f su pp or t* C ondi tio ns a ttache d t o s up po rt Su pp or t ma nage me nt , ho w adminis te re d 26 M oza m bi qu e: Ga bin et e de A po io à P op ul aç ão Vu ln erá ve l GAPVU (C ab in et for th e S up por t of V uln era ble Pe op le) [1990] [74] Ca sh Ta rg ets de stit ut e ur ban h ou seh ol ds , ho us eho ld s w ith pr eg na nt w om an w ith nu tri tio na l p ro bl ems (a naemi a a nd lo w w eig ht ga in), fem al e-he ad ed ho us eho ld s w ith ≥5 c hi ld ren , a nd o th er gr ou ps. To cr ea te a n urb an sa fet y n et To r ed uce p ov er ty am on g des tit ut e urb an h ou se ho ld s Tra nsf er o f a pp ro xim at ely US D1 p er m on th, b en ef its ad ju ste d t o h ou se ho ld size . Pr eg na nt w om en r ecei ve ben ef it f ro m t im e enr ol le d un til 6 m on th s a fter chi ld bir th. No ne Pr eg na nt w om en w ith p oo r nu tr itio n iden tif ie d b y AN C s ta ff, w ho r ef er w om en t o p rog ra mm e. 27 N ige ri a: Ca re o f th e P oo r (C O PE) [2008] [75] Ca sh Fem al e-h ea de d hou se hol ds , pr eg na nt wo m en, ot her g ro ups. C omm uni ties a re ta rg et ed , w ith m ea ns tes tin g. No t s ta te d M on th ly c as h t ra nsf er (b asic in co m e gu ara nt ee), dep en ds on n um ber o f c hi ldr en p er ho us eh old: 1 = US D9; 2 - 3 = US D18; ≥4 = US D31. Pr eg na nt w om en m us t s ho w ev iden ce o f a tten din g AN C. O th er co ndi tio ns f or o th er g ro ups. Pa id b y micr of in an ce a gen cies a nd lo ca l co mm uni ty b an ks, u su al ly t o mo the rs . 28 Pa na ma: Re d de O po rt unid ades (N et w or k o f O pp or tuni ties) [2004] [60,76] Ca sh (C CT) Fa m ili es li ving in ext rem e p ov er ty . Ini tia lly h ou se ho ld s se le ct ed t hr oug h ge og ra phic al t ar get in g an d p ro xy m ea ns t es t. Im plem en te d f irs t am on g in dig en ou s a nd rura l p op ul at io ns, a nd la ter in urb an a re as. To in cr ea se u se o f he al th, e duc at io n a nd ca paci ty-b ui ldin g ser vices To a lle vi at e p ov er ty an d p ro m ot e s oci al in clu sio n M on th ly p ay m en ts o f US D35 un til 2008 a nd t hen US D50 per fa mi ly Pr eg na nt w om en m us t s ho w ev iden ce o f a tten din g AN C a nd PN C, a nd r egu la r c he ck-u ps f or chi ldr en a ge d <5 y ea rs. Pa ym en ts di sb ur se d b im on th ly. Ca sh t ra nsf er s m ade t o w om en he ad s o f h ou se ho ld s. 29 Pa rag ua y: Re d de P ro te cció n y P ro m oció n So ci al (S oci al an d P ro te ct io n N et w or k), Te ko po ra [2005] [58] Ca sh (C CT) Pr eg na nt w om en i n ext rem e p ov er ty a nd ch ild ren a ge d <14 y ea rs, ru ra l a re as o nl y To co nt rib ut e t o re duc tio n in ext rem e po ver ty , a nd in cr ea se hum an a nd s oci al ca pit al M on th ly p ay m en ts f or fo od (US D10); h ea lth an d e duc at io n: US D5 p er chi ld a ge d 0 - 14 y ea rs o ld , ≤4 c hi ldr en/h ou se ho ld . M inim um US D15 (if 1 c hi ld); m axim um: US D30 (if ≥4 chi ldr en). Vi sits t o faci lit ies f or AN C, P N C an d c hi ld h ea lth; a nd a tten da nce a t ea rly c hi ld s tim ul at io n cen tres a nd sc ho ol . R eci pien ts sig n a gr eem en t. Bim on th ly p ay m en ts t o m ot her thr oug h b an ks. A dmini stra tiv e cos t ±10% o f p rog ra mm e b udg et. C on tin ue d ...

References

Related documents

VISSIM software was used to simulate the adjustment effect of import and export of the massive in saturated traffic conditions with the specific parameters such

firms, combined with financial information of the corporate clients and of the insurance provider, we apply a two-stage least squares (2SLS) approach to obtain consistent estimates of

Note: If the player is powered off by sliding the power switch to the Off position while the player is still running, all saved settings such as last song played or time

If the device is a repeater only, the Ethernet LED will not be illuminated and the number of green Signal Strength LEDs will depend on strength of connection to the

Objective: The overall objective of this IIEP blended course is to develop the capacities of higher education officials to design and implement quality assurance systems or

Priloga 3: Obra č un davka od dohodka pravnih oseb na vzor č nem primeru podjetja.

As this article illustrates, there is scope for helping forensic practitioners to avoid cognitive pitfalls (e.g. in exposure to gratuitous information or relying on memory)

of memory type (template versus accessory item) and search condition