title: Can cash transfers improve determinants of maternal mortality? Evidence from the household and community programs in Indonesia.
abstract: Despite global efforts in maternal health, 303,000 maternal deaths still occurred globally in 2015. One explanation is a considerable inequality in maternal mortality and the sources such as nutritional status and health utilization. One strategy to fight health inequality due to poverty is conditional cash transfer (CCT). Taking advantage of two large clustered-randomized trials in Indonesia from 2007 to 2009, this paper provides evidence on the effects of household cash transfers (PKH) and community cash transfers (Generasi) on determinants of maternal mortality. The sample sizes are 14,000 households for PKH and 12,000 households for Generasi. After two years of implementation, difference-in-differences (DID) analyses show that the two programs can improve determinants of maternal mortality with Generasi provides positive impact in some aspects of determinants, but PKH does not. Generasi improves maternal health knowledge, reduces financial barriers to accessing health services and improves utilization of health services, increases utilization among higher-risk women, improves posyandu equipment, and increases nutritional intake. As for PKH, evidence shows its strongest effects only on utilization of health services. Both programs, however, are unlikely to have a large effect on maternal mortality due to design and implementation issues that might significantly reduce program effectiveness. While the programs improved utilization, they did so at community-based facilities not equipped with emergency obstetric care. In the midst of popularity of household cash transfer, our results show that community cash transfer offers a viable policy alternative to improve the determinants of maternal mortality by allowing more flexibility in activities and at lower cost by monitoring at community level.
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, 655 Huntington Avenue, Boston, MA 02115, USA; Center for Health Economics and Policy Studies, Faculty of Public Health Universitas Indonesia, Kampus Baru UI, Depok 16424, Indonesia. Electronic address: dkusuma@mail.harvard.edu.
authors.forename: Dian
authors.initials: D
authors.lastname: Kusuma
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, 655 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, 655 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: McConnell
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, 655 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Berman
mesh_terms: D000328:Adult; D005191:Family Characteristics; D005260:Female; D054625:Healthcare Disparities / Q000592:standards* / Q000706:statistics & numerical data; D061889:Healthcare Financing; D006801:Humans; D007214:Indonesia; D008428:Maternal Mortality / Q000639:trends*; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data
keywords: Clustered-randomized trials; Community; Conditional cash transfers; Determinants of maternal mortality; Household; Indonesia