Impact of a Mobile Money–Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study

Abstract

Background: Mobile money–based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously. Objective: This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money–based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar. Methods: We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation. Results: The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care–seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P