Mobile Lotteries for Safe Births in Bangladesh & Kenya
In this decade, reproductive health voucher programs have successfully reduced maternal and infant mortality and morbidity through the innovative financing of reproductive health services. Among the ten active reproductive health voucher programs worldwide, Bangladesh and Kenya are key successes, with 191,000 combined voucher births in 2010, including significant rural populations; however, these programs face challenges scaling nationally because of: 1) high administrative overhead, 2) poor information management processes, and 3) weak demand-side incentives for voucher distribution and utilization.
To address these scale challenges in Bangladesh and Kenya, we propose the targeted use of incentives to mothers, their families, and community-based voucher distributors (CBDs). Mothers will be enrolled in routine lotteries for modest cash prizes after using the voucher to access antenatal care (ANC) and safe delivery. CBDs will receive fixed incentive payments after the mother's first ANC visit and after the mother's delivery. The lotteries and incentive payments can only be realized with improved voucher tracking, which will rely on an interactive SMS (short message service) system for voucher activation by CBDs and voucher verification by voucher service providers (VSPs). The system does not require mothers to own phones, as they will continue to use physical vouchers.
This system addresses the issues of national scale directly by: 1) lowering the cost of administrative overhead associated with CBD supervision, 2) improving the timeliness and quality of reporting by CBDs and voucher service providers, and 3) establishing incentives for CBDs, mothers, and the families of mothers to increase utilization of voucher services.