Effects of unconditional cash transfer status on maternal neonatal and child health service utilization among low-income households in Matiari, Sindh: a cross-sectional study
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Background Poverty has an unconstructive impact on health seeking behavior of the communities. To cater poverty, cash transfer mechanisms were introduced. There is insufficient evidence on the effectiveness of Benazir Income Support Program (BISP) on maternal, neonatal and child health (MNCH) service utilization in Pakistan. The aim of the study is to improve MNCH service utilization to contribute towards MDG 4 and 5. The primary objective of this study is to compare the MNCH service utilization among beneficiaries and non- beneficiaries of BISP, in Matiari. Methods An Analytical Cross-sectional study design was carried out during July-September 2012. Households were recruited through a multistage cluster sampling technique, covering all 19 union councils in Matiari. Local and trained data collectors interviewed study participants through a door to door survey, administering a structured questionnaire in 731 households. Households eligible for BISP, with at least 1 woman of reproductive age (15-45year of age), married, who has delivered in past 1.5 years and providing informed consent were included. Households not interested to participate; women or children with any congenital anomaly, physical or mental disability or any chronic disease were excluded. The outcome of the study was MNCH service utilization and it's OOP expenditure. Data was double entered and cleaned in Visual FoxPro 9. Data analysis was carried out on Statistical Package for Social Sciences (SPSS) version 19. Findings During this study, 222 recipients and 509 non-recipients were interviewed. There was no significant difference in health service utilization for ANC [PRAdj:1.1; 95% CI (0.9-1.3)], natal care [PRAdj: 1; 95% CI (0.8-1.2)], PNC [PRAdj:1; 95% CI (0.8-1.4)l, vaccination [PRAdj: 1; 95% CI (0.8-1.2)], growth monitoring [PRAdj: 1.1; 95% CI (0.8-1.3)], and services for other ailments [PRAdj: 1.1; 95% CI (0.9-1.3)] depending on BISP enrolment status, after adjusting for other variables, with p-value <0.05 considered significant for multivariable regression analysis. However, some variables which were not fulfilling these criteria were kept in the final model because of their biological plausibility. Conclusion BISP had no effect of WINCH service utilization. However, factors like socioeconomic status, maternal education, and care seeking patterns were important independent factors for health service utilization. It is recommended to carry out a comprehensive third-party evaluation of BISP, especially the processes related to the targeting of the BISP recipients. Further, a conditional cash transfer program is suggested; besides improving the household income, CCTs will be cost-effective to improve health service utilization behaviors of the low-income household.
Khowaja, A. H. (2012). Effects of unconditional cash transfer status on maternal neonatal and child health service utilization among low-income households in Matiari, Sindh: a cross-sectional study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.