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Objective – Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the aim of encouraging greater use of professional care at childbirth. It provided cash to women giving birth in a public health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We aimed to assess the impact of the programme on neonatal mortality and health care seeking behaviour at childbirth in one district of Nepal.

Methods – Impacts were identified using an interrupted time series approach, applied to household data. We estimated a model linking the level of each outcome at a point in time to the start of the programme, demographic controls, a vector of time variables and community-level fixed effects.

Findings – The recipients of the cash transfer in the programme's first two years were disproportionately wealthier households, reflecting existing inequality in the use of government maternity services. In places with women's groups – where information about the policy was widely disseminated – the SDIP substantially increased skilled birth attendance, but failed to impact on either neonatal mortality or the caesarean section rate. In places with no women's groups, the SDIP had no impact on utilisation outcomes or neonatal mortality.

Implications for policy – The lack of any impact on neonatal mortality suggests that greater increases in utilisation or better quality of care are needed to improve health outcomes. The SDIP changed health care seeking behaviour only in those areas with women's groups highlighting the importance of effective communication of the policy to the wider public.

Conditional Cash Transfer (CCT) aims to assist expectant mothers in low-income households. It might address the insufficient prenatal and postnatal healthcare services in rural areas of low-income nations, including Bangladesh. However, the effectiveness of such intervention is rarely investigated in rural Bangladesh. The study aims to explore the impact of CCT on certain health outcomes of expectant mothers in southwestern rural Bangladesh.

The study applied the quasi-experimental Propensity Score Matching method to assess the effectiveness of CCT in health outcomes of expectant mothers. The authors also deployed logistic regression to explore the predictors of three health issues – blood pressure, hemoglobin adequacy and morning sickness.

The Average Treatment Effect shows that the CCT program significantly improves maternal health by lowering the extent of blood pressure and morning sickness and enhancing the hemoglobin adequacy of the CCT recipient women compared to the non-recipient. The result reveals that CCT beneficiary status as well as the education and immunization are positively and significantly associated with normal blood pressure and hemoglobin adequacy. CCT is also a negative predictor of morning sickness. The study recommends to expand the coverage of the CCT program and also emphasize on the improvement of education, training and immunization for rural pregnant women.

To assist in scaling purchasing power and nutritious food for poor pregnant and lactating mothers in low-income households, “Nobojatra” project initiated the CCTs in the southwest region of Bangladesh. Yet, the impact of such cash transfers on their health outcomes is rarely explored in the context of Bangladesh. This study provides evidence regarding the effectiveness of cash transfers to pregnant women of low-income households in rural Bangladesh.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2022-0512

Bipolar and depression disorders are some of the most common mental health disorders affecting millions of people in low-and middle-income countries, including those in Africa. These disorders are therefore major contributors to the burden of diseases and disability. While an enhancement in income is seen as a major approach towards reducing the burden of these disorders, empirical evidence to support this view in the African context is lacking. This study therefore aims to examine the effect of per capita income growth on bipolar and depression disorders across African countries.

The study uses data from secondary sources comprising 42 African countries over the period, 2002–2019, to achieve its objective. The prevalence of bipolar and major depressive disorders (depression) are used as the dependent variables, while per capita income growth is used as the main independent variable. The system Generalised Method of Moments regression is used as the estimation technique.

In the baseline, the authors find per capita income growth to be associated with a reduction in the prevalence of bipolar (coefficient: −0.001, p < 0.01) and depression (coefficient: −0.001, p < 0.1) in the short-term. Similarly, in the long-term, per capita income growth is found to have negative association with the prevalence of bipolar (coefficient: −0.059, p < 0.01) and depression (coefficient: −0.035, p < 0.1). The results are similar after robustness checks.

This study attempts at providing the first empirical evidence of the effect of per capita income growth on bipolar and depression disorders across several African countries.

Objective – The first wave of experiences of exemptions policies suggested that poverty-based exemptions, using individual targeting, were not effective, for practical and political economic reasons. In response, many countries have changed their approach in recent years – while maintaining user fees as a necessary source of revenue for facilities, they have been switching to categorical targeting, offering exemptions based on high-priority services or population groups. This chapter aims to examine the impact and conditions for effectiveness of this recent health finance modality.

Methodology/approach – The chapter is based on a literature review and on data from two complex evaluations of national fee exemption policies for delivery care in West Africa (Ghana and Senegal). A conceptual framework for analysing the impact of exemption policies is developed and used. Although the analysis focuses on exemption for deliveries, the framework and findings are likely to be generalisable to other service- or population-based exemptions.

Findings – The chapter presents background information on the nature of delivery exemptions, the drivers for their use, their scale and common modalities in low-income countries. It then looks at evidence of their impact, on utilisation, quality of care and equity and investigates their cost-effectiveness. The final section presents lessons on implementation and implications for policy-makers, including the acceptability and sustainability of exemptions and how they compare to other possible mechanisms.

Implications for policy – The chapter concludes that funded service- or group-based exemptions offer a simple, potentially effective route to mitigating inequity and inefficiency in the health systems of low-income countries. However, there are a number of key constraints. One is the fungibility of resources at health facility level. The second is the difficulty of sustaining a separate funding stream over the medium to long term. The third is the arbitrary basis for selecting high-priority services for exemption. The chapter therefore concludes that this financing mode is unstable and is likely to be transitional.

The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators.

A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically.

Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources.

It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC.

This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.

The purpose of this conceptual paper is to present the scope of telemedicine, current state of telemedicine in India, challenges in its diffusion and suggest the way forward for implementation of such initiatives.

This is a viewpoint paper that is prepared based on authors’ exposure and knowledge about research topic and the context. A number of appropriate and current citations have been utilised to illustrate current state on the topic as well as to support authors arguments presented in this paper.

The discussion presented in this paper suggests that optimal utilisation of technology in healthcare delivery system requires overcoming barriers at multiple levels including policy, resources and socio-cultural levels. Successful implementation of telemedicine entails involvement of all the stakeholders, namely, the specialists, general duty doctors, paramedical personnel, technical staff, coordination staff, policymakers and, most importantly, the target community, from the design stage itself.

The primary value of this paper lies in providing an overview of current state of telemedicine development in India. It is believed that this article will act as a precursor to future articles on this topic.

The purpose of the study is to investigate the factors responsible for the utilisation of safe motherhood practices under the Government of India (GOI)-run maternal health programme Janani Suraksha Yojana (JSY).

Data for the survey were collected from 435 expectant mothers registered under JSY from seven districts of western Uttar Pradesh, India. Based on the existing theories of behaviour change and the social marketing framework, a model of antecedents of adoption of safe motherhood practices was tested out empirically.

The results suggested that controlling for demographic variables such as age, education, number of children, intention to follow safe motherhood practices, maternal health self-efficacy, attitude towards safe motherhood, life satisfaction and facilitating conditions all contributed towards the adoption of safe motherhood practices. However, facilitating conditions moderated the relationship between intention to follow safe motherhood practices and adoption of safe motherhood practices.

The study focused only on maternal health, excluding child health under JSY.

The study findings suggest that social marketers should focus on the individual (micro)- as well as programme (macro)-level factors to bring about systemic behaviour change.

The adoption of safe motherhood practices will result in a reduction of the maternal mortality rate. This will improve the overall health of mother and child.

The JSY programme is targeted at promoting safe motherhood practices among poor women in the reproductive age group from India. The adoption of safe motherhood practices will result in less maternal mortality and contribute to the well-being of the family.

In Covid-19 pandemic era when most households' members have lost their jobs and incomes, the government assistance and programs in ensuring household consumption smoothing is very significant. The main objectives of this study are to analyze the impact of government expenditure and free maternal healthcare (FMHC) policy on household consumption expenditure in Ghana in both long run and short run.

They used the ARDL to estimate the impact of government expenditure on household consumption and Segmented Linear Regression to examine impact of FMHC policy household consumption using longitudinal data from 1967 to 2018.

The results revealed that government expenditure had a negative and statistically significant effect on household consumption expenditure suggesting that government expenditure crowed-out private consumption in Ghana. Also, it was observed that before the implementation of the FMHC policy, there was an increase household consumption expenditure, but after the introduction of the FMHC policy, the study household consumption expenditure decreases significantly suggesting that FMHC policy has strong association with household consumption in Ghana.

Due to limited data availability, this study did not assess the impact of the FMHC policy at the household or district level. Also, Ghana has introduced a free senior high school education policy in 2017 so further research could analyze the implications of these policies for household consumption in Ghana at the micro-level using different estimation technique such as the difference in difference.

The study suggests the need to increase public spending on basic social amenities and also extend the free maternal healthcare policy to all pregnant women especially those in the rural areas of Ghana as these have a greater impact on household consumption in Ghana. The findings from this study have important implications for household savings and interest rate in Ghana. The findings from this study also have important implications for both fiscal policy and healthcare policy in Ghana and other developing countries.

To the best of my knowledge this is the first empirical study to examine the effect of government expenditure and free maternal healthcare policy on household consumption in Ghana.

The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.

The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.

The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.

The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.

This was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.

The four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.

This paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.