INCENTIVE VALUE OF CASH IN A CONDITIONAL CASH TRANSFER PROGRAM FOR MATERNAL AND CHILD HEALTH AND NUTRITION IN MALI

Background and objectives: The "Cash for Nutrition Awareness" (CNA) component of the community-based intervention "Sante Nutritionnelle a Assise Communautaire a Kayes" (SNACK) was implemented in Mali by the World Food Program (WFP-Mali) in 2013 for a duration of 3 years. The conditional cash transfer program aimed at improving child nutrition outcomes by increasing maternal and child attendance at community health centers (CHCs) through the distribution of a small amount of cash (~$3.00-$12.00 USD), during antenatal visits, delivery, vaccination and monthly growth monitoring visits starting at 6 months, covering the "1000 days" period (i.e. from pregnancy to 23 months of age of the child). The objective of this study was to explore the incentive value of the cash for beneficiaries to attend CHCs. Methods: We conducted a process evaluation two years after the start of the program, using a purposive sample of 12 CHCs and their catchment area. We collected data using semi-structured interviews with frontline workers (n=76) and mothers (n=24), semi-structured observations of cash distributions and services delivered in 11 CHCs (twice for each CHC, n=22), and free listing with groups of up to 10 mothers gathered outside the CHCs (n=24 groups). Data were analyzed using thematic analysis along the program impact pathway (from service delivery to beneficiaries' receipt and use of cash). Results: We identified various implementation issues, including difficulties for program workers to supply the cash to the CHCs due to a challenging implementation environment (namely long travel distances to deliver cash to the CHCs and high workloads). In addition, some mothers returned home empty-handed, as the total amount of cash available was often insufficient to pay all women attending the CHC in the same day. In some CHCs, cash was also delivered on different days than the days they provided services. Beneficiaries identified maternal and child health as their main motivation to attend activities at the CHCs and cash only as a benefit, mainly used to buy food. Conclusions: Implementation issues and a potentially insufficient amount of cash may have decreased the incentive value of the cash to increase attendance at CHCs. The research was funded by UNICEF, EC (IFAD) and CGIAR (A4NH).