Conditional Cash Transfer improves maternal health


For 31-year-old Dedirai Blessings, the fourth child didn’t come as a surprise because it was a result of her husband’s insistence.

However, Dedirai’s husband did this without considering the cost but deep down her heart she knew that it would be heavy both physically and economically.

Dedirai knew she was the one to accommodate the unborn baby in her womb for nine months and also shoulder the burden of looking for transport money to attend ante-natal clinic, 18 kilometres away from her Pinda Village in Traditional Authority (T/A) Mlonyeni in Mchinji.


“I live far away from the hospital and transport to and from the hospital is expensive and to make matters, worse none of us is employed.”

Basically, Pinda lies in the middle of nowhere and to get to the nearest hospital which is either Mkhwazi or Mchinji District Hospital, she has to fork out K1200 for kabaza (bicycle).

Dedirai would get up as early as 2am to set off for the hospital but with Expected Date of Delivery (EDD) nearing, she had difficulties to keep time.


However, Dedirai can now afford a smile because of Result Based Financing for Maternal and Neonatal Health (RBF4MNH) programme, an ambitious initiative which would see her receive Conditional Cash Transfer for transport, wrapper to be used during delivery and an upkeep allowance all amounting to K6500.

According to Reagan Kaluluma, RBF4MNH programme deputy director, it is aimed at contributing to the reduction of maternal and neonatal mortality and morbidity by providing incentives that lead to improved quality of maternal and neonatal health services, increased deliveries at health facility level and creation of awareness and means for pregnant women to come on time to access services.

He said RBF4MNH uses incentives and rewards to improve health care provider performance and the quality of maternal services.

Some of the Conditional Cash Transfer criteria are that the expectant woman should be Malawian, attend ante-natal and come from health facility catchment area apart from staying at hospital for 24 to 48hours after delivery.

He said RBF4MNH will change health seeking behaviour and increase deliveries at health facilities through provision of better quality services.

The project is being implemented in Balaka, Ntcheu, Dedza and Mchinji.

District Health Officer (DHO) for Mchinji, Chimwemwe Banda, said his district has seven health centres benefitting from the programme which are Mkanda, Kochilira, Nkhwazi, Chipumi, Kapiri, Chioshya and Mchinji DHO.

“We have witnessed great improvements in infrastructure and equipment for maternal health, apart from receiving infection prevention items such as soap, buckets, gloves and pharmaceuticals,” Banda said.

He said quality of care has improved because the incentives given to health workers motivate them to work hard. Banda said quarterly RBF4MNH cash disbursement could reach about K9 million, part of which was used to construct a High Dependency Unit (HDU) which caters for women who have delivery complications.

Banda’s counterpart in Balaka, Bertha Chikuse, said her hospital has been scooping position one ever since RBF4MNH was introduced in 2012.

“We have been a successful team due to good coordination of health workers from all out-stations and other stakeholders in the health delivery system. We have sensitised communities on the need to have pregnant women deliver under skilled attendance and given incentives such as transport, money for food, wrappers, to all that come to deliver at hospitals apart from introducing staff performance related monetary awards to improve on service delivery,” Chikuse said.

She said on infrastructure, Balaka has benefited from the rehabilitation of maternity wings and construction of waiting homes in some of the participating health centres.

George Nga Ntafu, Chief Technical Adviser in the Ministry of Health said recently during a media briefing on RBF4MNH at Liwonde, the concept of rewarding results as adopted by the initiative will enable the ministry provide better services, modern infrastructure, improve healthcare provider performance and the quality of maternal services.

Paramount Chief Gomani V, RBF4MNH chairperson, said women are needlessly dying in the hands of traditional birth attendants and the initiative is encouraging them to deliver at hospitals where not only motivated staff and quality care is available but monetary rewards are also given to them.

“We would like to see to it that apart from wooing more expectant mothers to patronize ante-natal clinics earlier, there is conducive environment at health institutions through provision of infrastructure such as health homes, medical equipment, Conditional Cash Transfers for women that attend ante-natal clinics and those that deliver at health institutions,” Gomani said.

However, after a tour of RBF4MNH activities in all the participating districts, Gomani questioned the attitude of some health workers and nurses towards patients and pregnant women, saying there was need to address the problem urgently to encourage the women to deliver at the hospital.

“Pregnant women should be handled with utmost care. They need a friendly environment by health workers so that they don’t refrain from delivering at the health facilities,” he said.

RBF4MNH programme director, Matthew Nviiri, said the initiative has become a silver bullet that has improved quality of healthcare and reduced maternal and newborn mortality in Malawi.

He said in order to encourage women to come to health facilities for delivery, the initiative provides conditional cash transfers and more than 7000 women have so far benefited from the programme.

Nviiri said provision of cash transfers prevent delays in providing services and enable women to seek quality care on time and contribute towards the reduction of maternal and newborn mortality.

“We want to ensure that Malawi government appreciates and adopts RBF4MNH as funding mechanism and this will only be realised through increased advocacy and sharing best results from the programme and we hope that with media support, the programme will become a universal language that will be spoken and understood by everyone within Malawi,” Nviiri said.

He said in a country like Malawi, with limited resources, paying for results was the only way to maximise the impact of money spent on health care system.

The RBF4MNH initiative continues to support the Ministry of Health to reduce maternal and newborn mortality rate in Malawi.

More than 48,678 women have delivered at RBF4MNH supported health facilities while 28 health facilities have signed performance agreements which have enabled them to improve the quality of MNH services offered at these facilities.

The initiative has enabled facilities to be autonomous in decision making. Health facilities have earned financial incentives which they have used to procure supplies like gloves, cleaning materials and medicine.

The German and Royal Norwegian government committed US$10 million in Phase One and 10 million euro in Phase Two of the project which is being implemented in the four districts, supporting 28 health facilities.

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