Demand‐side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low‐ and middle‐income countries

The original systematic review has been updated and published in the form of two open access papers available here (DSF for maternal and newborn health) and here (The effects of cash transfers and vouchers on the use and quality of maternity care services)

For three modes of demand-side financing (conditional cash transfers, payments to offset costs of access to maternal healthcare, and vouchers for maternity services) the review found evidence relevant to the utilisation of maternal health services, barriers to the provision of demand-side financing and supply-side preconditions to implementing demand-side financing schemes. There was insufficient evidence to provide comprehensive answers for the effect of demand-side financing interventions on maternal, perinatal and infant health outcomes and on the social and financial situation of underprivileged women.  There was also insufficient evidence on the cost-effectiveness of demand-side financing interventions and preconditions for sustainability and scale-up of demand-side financing schemes.

Implications for practice:

Salient recommendations for policymakers regarding demand-side financing for maternal health derived from the current evidence are:

Streamlined policy goals focused on increasing utilisation of services are most effective.

Careful design of incentives for skilled practitioners is required.

Demand-side financing mechanisms cannot on their own improve quality of services; supply-side measures are required to complement these.

Simple and transparent processes for administering and disbursing benefits are more likely to be successful in improving uptake of services.

Careful planning for initial and scaled up demand-side financing is essential to success, including input from women’s organisations and other user representatives.

Demand-side financing can be an effective targeting mechanism but only if it does not require substantially new systems for identifying beneficiaries.

Policy should recognise that even well-designed demand-side financing schemes may fail to function as intended unless other barriers are addressed.

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