PHA-Exchange> Monetary incentives in primary health care - Rural Honduras:

[Claudio]

From: Ruggiero, Mrs. Ana Lucia (WDC) 


Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in 
rural Honduras: cluster randomised trial  

 

Saul S Morris,  Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK 
Rafael Flores, Rollins School of Public Health, Emory University, Atlanta 

Pedro Olinto, Juan Manuel Medina, Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington DC, USA 

Lancet 2004; 364: 2030-37 - Volume 364, Number 9450     04 December 2004

 

Available free online  HTML: http://www.thelancet.com/journal/vol364/iss9450/full/llan.364.9450.primary_research.31390.1 


PDF file [8p.] at:   http://pdf.thelancet.com/pdfdownload?uid=llan.364.9450.primary_research.31390.1&x=x.pdf  

 

      Summary 
     

Background Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries 

by lack of demand. In Latin America, some governments have been trying to increase demand for health interventions by making direct 
payments to poor households contingent on them keeping up-to-date with preventive health services. We undertook a public health 
programme effectiveness trial in Honduras to assess this approach, contrasting it with a direct transfer of resources to local health teams. 


Methods 70 municipalities were selected because they had the country's highest prevalence of malnutrition. They were allocated at 
random to four groups: money to households; resources to local health teams combined with a community-based nutrition intervention;
both packages; and neither. Evaluation surveys of about 5600 households were undertaken at baseline and roughly 2 years later. 
Pregnant women and mothers of children younger than 3 years old were asked about use of health services (primary outcome) and 
coverage of interventions such as immunisation and growth monitoring (secondary outcome). Reports were supplemented with data 
from children's health cards and government service utilisation data. Analysis was by mixed effects regression, accounting for the 
municipality-level randomisation. 


Findings The household-level intervention had a large impact (15-20 percentage points; p<0·01) on the reported coverage of antenatal
 care and well-child check-ups. Childhood immunisation series could thus be started more opportunely, and the coverage of growth 
monitoring was markedly increased (15-21 percentage points; p<0·01. Measles and tetanus toxoid immunisation were not affected. 
The transfer of resources to local health teams could not be implemented properly because of legal complications. 


Interpretation Conditional payments to households increase the use and coverage of preventive health care interventions. 

 



-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20041211/00907a6a/attachment-0001.html>