Increasing healthy behaviors and use of reproductive health services through improved quality of care, novel incentives, information technology, and enhanced demand for health products

RAND Corporation
Organization Location: 
Santa Monica, CA USA

In Nyanza Province, Kenya, there are nearly 5 maternal deaths and 39 neonatal deaths for every 1000 live births. These high mortality rates largely stem from little and low-quality health care, endemic malaria, lack of safe water, sanitation and hygiene, and deep poverty. Such problems arise in part because of underdeveloped systems to distribute information, goods and services to poor rural women. We propose a comprehensive integrated program to address the comprehensive interrelated factors leading to poor maternal and child health. We combine service delivery improvements with demand-side innovations and multiple mobile phone applications. These include safe delivery kits, insurance for transport and treatment of obstetric emergencies, safe water and hygiene products, and small incentives for women to start ANC early. Because pregnancy is a "teachable moment," we use ANC visits to promote a range of behaviors and products. As the women we will serve are largely very poor, we will combine free product trials, incremental time payments and mobile banking to increase their ability and willingness to pay. Text messages will promote safe pregnancy and healthy behaviors, provide ANC appointment reminders, and gather feedback on service quality. We will also provide training and supplies to providers, along with small incentives for provider quality. Combining incentives, economies of scope, and new technologies should greatly increase use of ANC and adoption of health-promoting products and behaviors. This is the first attempt to integrate ANC with new financing and marketing approaches for multiple health-improving goods and services.

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