The impact of monetary incentives on referrals by traditional birth attendants for postnatal care in Nigeria

Adanna Chukwuma, Chinyere Mbachu, Margaret McConnell, Thomas J Bossert, Jessica Cohen, Adanna Chukwuma, Chinyere Mbachu, Margaret McConnell, Thomas J Bossert, Jessica Cohen

Abstract

Background: Gaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA's advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria.

Methods: We conducted a non-blinded, individually-randomized, controlled study of 207 TBAs in Ebonyi State, Nigeria between August and December 2016. TBAs were randomly assigned with a 50-50 probability to receive $2.00 for every maternal client that attended postnatal care within 48 h of delivery (treatment group) or to receive no monetary incentive (control group). We compared the probabilities of maternal and neonatal postnatal care use within 48 h of delivery in treatment and control groups in an intention-to-treat analysis. We also ascertained if the care received by mothers and newborns during these visits followed World Health Organization guidelines.

Results: Overall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9-22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9-19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits.

Conclusions: We show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance.

Trial registration: The trial was retrospectively registered in clinicaltrials.gov ( NCT02936869 ) on October 18, 2016.

Keywords: Health; Incentives; Maternal; Neonatal; Postnatal; Referrals; Traditional birth attendants.

Conflict of interest statement

The motivations, findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram describing the flow of participants through the intervention
Fig. 2
Fig. 2
Self-reported motivations for postnatal care attendance among TBA clients
Fig. 3
Fig. 3
Self-reported experience of maternal postnatal care
Fig. 4
Fig. 4
Self-reported experience of neonatal postnatal care

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Source: PubMed

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