Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven strategies that
can tackle the high burden of maternal and child mortality and morbidity currently witnessed
in sub-Saharan Africa. However very few pregnant women utilize these services. This study
aims to assess the impact, cost-effectiveness, and scalability of conditional cash transfers
(CCTs) to promote increased and uninterrupted contact between pregnant women and the formal
healthcare system in Siaya County, Kenya.
The study is a cluster randomized controlled trial with the intervention being a conditional
cash transfer to women each time they honour their health appointments for ANC, facility
birth and PNC visits until their new-borns reach 1 year of age. Study participants are
pregnant women identified during their first ANC visit (n = 7200), and their subsequent
new-borns. Mothers and their children are followed up throughout their health visits and at 3
additional time points. Trial clusters are 48 public primary health facilities, (24 in the
intervention arm and 24 in the control arm).
The primary outcomes are: a) proportion of all eligible ANC visits made during pregnancy; b)
delivery at health facility; c) proportion of all eligible PNC visits honoured; d) proportion
of referrals honoured during pregnancy and postnatal period; e) proportion of child
immunizations received. Secondary outcomes include; health screening and infection control,
live birth, maternal and child survival 48 hours after delivery, exclusive breastfeeding,
birth spacing and self-rated wellness of mother and new-born at respective time points.
Primary outcomes will be measured through abstraction of health records at the health
facilities attended by the women during the trial period and supplemented by data collection
using an electronic based system that comprises of a card and reader system installed at
recruited study facilities. Secondary data will be abstracted from the women's medical
records at the health facilities and supplemented by telephone surveys administered at three
time-points over the course of the study. Additional quantitative and qualitative data will
be collected through questionnaires and phone interviews for process and economic
This trial will contribute to evidence on effectiveness and cost-effectiveness of conditional
cash transfers in facilitating health visits and promoting maternal and child health in Kenya
and other similar contexts.