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Exploring the Impact of Conditional Cash Transfers in Afghanistan to Improve Maternal and Child Health

2010 –2012 || U.S. Agency for International Development

Abstract

Despite notable improvements in the health sector over the past decade, Afghanistan continues to face challenges in key health indicators, with the maternal mortality ratio and infant mortality rate remaining amongst the highest in the world. In 2008 the Ministry of Public Health (MoPH), launched a conditional cash transfer project (CCT) to address low utilization of specific health services. As part of the Health Systems 20/20 project, Deloitte and its collaborators are supporting the evaluation of the CCT pilot program to determine its effectiveness in encouraging mothers to utilize institutional delivery and obtain vaccinations for their children.

The Challenge

First introduced in Latin America and now expanding to Africa and Asia, conditional cash transfers are interventions that provide monetary transfers to target populations, conditioned on a set of social behaviors. While evidence in favor of CCTs for low and middle income countries is growing, little is known about the effect of CCTs in post-conflict settings where resources are stretched, service provision limited, and security tenuous. Furthermore, challenges abound in implementing, monitoring, and evaluating CCT programs in these settings. For this reason, the MoPH in Afghanistan needed support in evaluating the CCT pilot program in order to inform programmatic and policy decisions.

How We Helped

The Health Systems 20/20 project team is collaborating with the Health Economics and Financing Directorate (HEFD) of Afghanistan’s MoPH to strengthen the Ministry’s capacity in conducting policy relevant studies related to health financing and economics, including the evaluation of the CCT project.

The Afghan CCT project provides cash incentives to women for institutional delivery and completion of pentavalent vaccination (DPT3) series for children under the age of two as well as to community health workers for referrals for these services. The objectives of the project evaluation are: (1) to assess the impact of the CCT on utilization of institutional delivery and DPT3 vaccination in Afghanistan; and (2) to understand contextual and process factors that affect program implementation.

Analysis will be based on two household surveys (baseline and endline) conducted by a local non-governmental organization, facility records collected through the MoPH Health Management Information System, and qualitative research conducted by the Health Systems 20/20 team. The evaluation design and methodology have been completed and the current phase of support is focused on analyzing household data and planning the qualitative research component. Evaluation results are expected in late 2011.

Solution

In Afghanistan, exploring various incentive strategies to increase service utilization is critical to improve health outcomes. Conditional cash transfers can be an effective policy tool to stimulate demand for health services. However, design, implementation, and evaluation of CCT programs require careful consideration. The current study is expected to assist the MoPH in determining if CCTs are an effective incentive strategy to address low utilization of health services in the Afghan context.

Deloitte’s work in Afghanistan under Health Systems 20/20 is carried out under a subcontract with Abt Associates Inc., prime contractor for the Health Systems 20/20 cooperative agreement. Health Systems 20/20 is funded through the generous support of the American people through the U.S. Agency for International Development (USAID). The project helps USAID-supported countries address health system barriers to the use of life-saving priority health services. In the process, the project works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions.

As used in this document, “Deloitte” means Deloitte Consulting LLP, which provides strategy, operations, technology, and human capital consulting services, Deloitte Financial Advisory Services LLP, which provides financial advisory services, and Deloitte & Touche LLP which provides governance and risk oversight and reporting advisory services. These entities are separate subsidiaries of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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