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Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries

M F Chersich, S Luchters, D Blaauw, F Scorgie, E Kern, A van den Heever, H Rees, E Peach, S Kharadi, S Fonn

Abstract


Background. Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants.

Objectives. To review design and operational features of pregnancy support programmes, highlighting features that promote their effectiveness and efficiency, and implications thereof for SA.

Methods. Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries.

Results. Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support.

Conclusions. Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.


Authors' affiliations

M F Chersich, Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Luchters, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Medicine, Nursing and Health Sciences, Monash University, Australia; International Centre for Reproductive Health, Department of Urogynaecology, Faculty of Medicine and Health Sciences, Ghent University, Belgium

D Blaauw, Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

F Scorgie, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

E Kern, Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

A van den Heever, Wits School of Governance, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa

H Rees, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

E Peach, Burnet Institute, Melbourne, Australia

S Kharadi, Independent consultant, Toronto, Canada

S Fonn, Gender and Health Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Social support; Cash transfers; Maternal and child health; South Africa; Maternity; Systematic review; Child Support grant

Cite this article

South African Medical Journal 2016;106(12):1192-1210. DOI:10.7196/SAMJ.2017.v106i12.12011

Article History

Date submitted: 2016-12-01
Date published: 2016-12-01

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