Improving maternal and child health care in Nigeria: an assessment of the maternal and child care component of the Subsidy Reinvestment & Empowerment Programme (SURE-p MCH)

INTERVENTION: The study will be implemented in two phases. In Phase I, two interventions will be studied using a 4x2 factorial: one trial will be on incentives aimed at improving midwife retention; the other trial will be an information and community mobilization campaign designed to reduce drug stockouts at the primary health centre level. The trial dedicated to improve midwife retention will have the following arms (1) monetary incentives, (2) non‐monetary incentives, (3) monetary plus non‐monetary incentives, (4) no incentives. The incentives will be paid every three months to the midwives that stay in their post. The trial dedicated to reduce drug stock outs will only have two arms: (1) implementation of information campaign, (2) no implementation of information campaigns. Details on the implementation of the information campaign must still be decided. Phase I will start in September 2013. In Phase II, another 4x2 factorial design will be implemented: the same trial on incentives to improve midwife retention as in Phase I and a second trial consisting on a conditional cash transfer program (CCT) to increase antenatal care and delivery in PHCs. This latter trial will have two arms: (1) implementation of the CCT program, (2) no implementation of the CCT program. The CCT amounts to N5,000 and is payable to mothers who meet the following pre‐conditions: at least 4 ante‐natal care visits, delivery by skilled birth attendants and immediate postnatal care visit. Phase II will start in November 2014. SURE‐P is an intervention that combines the interventions above with the deployment of midwives and upgrading of primary health centres. Its overall impact will be assessed non‐experimentally during Phase II of the study. The control group for this observational component will comprise clusters where SURE‐P is not implemented. Details of the Co‐ PIs: 1. Dr Pedro Rosa Dias Lecturer in Economics Room 264, Jubilee Building, University of Sussex, Falmer, Brighton, BN1 9SL. UK 2. Dr Ma CONDITION: Maternal and Child Health ; Pregnancy and Childbirth INCLUSION CRITERIA: 1. SURE‐P midwives deployed in a Primary Health Centre 2. Women who have given birth in the three months prior to the beginning of the study PRIMARY OUTCOME: All primary outcomes will be measured using structured questionnaires.; ; For the trial on incentives to improve midwife retention:; 1. Percentage of SURE‐P midwives that were working in a SURE‐P Primary Health Centre at follow‐up amongst those midwives that were working in a SURE‐P Primary Health Facility at baseline.; ; For the trial on Conditional Cash Transfer:; 1. Percentage of women that had an institutional delivery. Information will be collected using structured questionnaires administered to women who gave birth 3 months prior to the follow‐up interview.; 2. Percentage of women that attended 4 or more antenatal visits. Information will be collected using structured questionnaires administered to women who gave birth 3 months prior to the follow‐up interview.; ; For the trial on reducing drug stock outs; 1. Average number of days that that essential drugs for antenatal and obstetric care were not available in SURE‐P Primary Health Centres.; ; For the overall evaluation of SURE‐P:; 1. Percentage of women who had an institutional delivery. Information will be collected using structured questionnaires administered to women who gave birth 3 months prior to the follow‐up interview.; 2. Percentage of women who attended 4 or more antenatal visits. Information will be collected using structured questionnaires administered to women who gave birth 3 months prior to the follow‐up interview. SECONDARY OUTCOME: For the trial on incentives to improve midwife retention:; 1. Maslach Burnout Inventory of Midwives ; 2. Midwives absenteeism; 3. Infant mortality collected through an extension of the sisterhood method; 4. Average consultation time in the last antenatal visit; 5. Readmissions and other measures of midwives? performance; 6. Pregnancy and obstetric related health care practices; ; For the trial on Conditional Cash Transfer:; 1. Post partum depression assessed using the Edinburgh Post Partum Depression Scale; 2. Infant mortality collected through an extension of the sisterhood method; 3. Pregnancy and obstetric related health care practices; ; For the trial on reducing drug stock outs; 1. Out of pocket payments for antenatal care drugs; 2. Proportion of women who could not obtain from the Primary Health Centre antenatal care drugs recommended to her by the primary health centre clinical staff. ; ; For the overall evaluation of SURE‐P:; 1. Post partum depression assessed using the Edinburgh Post Partum Depression Scale; 2. Infant mortality collected through an extension of the sisterhood method; 3. Pregnancy and obstetric related health care practices