Women’s Stated Preferences for Conditional Cash Transfer Programs Focused on Maternal and Child Health and Nutrition in India (P22-012-19)

Abstract

Objectives Conditional Cash Transfers (CCTs) are important national strategies to improve maternal and child health and nutrition. India recently began implementing a Maternity Benefit Program (MBP) to encourage health care use during pregnancy and early childhood; under discussion is to include child nutrition services within a CCT program. This paper aims to understand the preferences of mothers with young children for design features (cash transfer amount and conditionalities) of CCT programs. Methods We conducted a Discrete Choice Experiment in Uttar Pradesh, India where 405 mothers with children below three years of age were interviewed. Respondents were presented 18 hypothetical CCT program profiles defined by five attributes – cash transfer amount, number of ante-natal care visits, number of visits for child immunization/growth monitoring, time taken to complete a visit, and health benefit received (proxy for service quality). Conditional logit regression was used to analyze respondent choices. Results Mothers valued the amount of cash transfer, quality of services, and quicker health center visits. They did not have a strong preference for the number of visits required. Higher cash amounts are associated with greater probability of participation. For any given amount of cash amount, better service quality (produced better health) elicited greater participation. Mothers put high valuation on service quality; they were willing-to-pay (give up) INR 2858 ($41) for a program that produced good health. Without any cash transfer, only improving service quality from average to good would increase participation by 27%. A cash transfer amount of INR 6000 ($86, currently offered by MBP) combined with fair (good) quality services would increase participation by 78% (85%). Preference for CCT programs differed across sub-groups defined by prior users of government health services and socioeconomic status. Poor households valued a given cash transfer amount more than better-off households, while better-off households valued good health outcomes more than poorer households. Conclusions Aligning maternal and child health CCT programs with user preferences can increase program participation. This study provides guidance on incorporating user preferences in the CCT program design. Funding Sources Department of International Health, Johns Hopkins University.