Hunter Benjamin M, Harrison Sean, Portela Anayda, Bick Debra
Department of International Development, King's College London, London, United Kingdom.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
PLoS One. 2017 Mar 22;12(3):e0173068. doi: 10.1371/journal.pone.0173068. eCollection 2017.
Cash transfers and vouchers are forms of 'demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.
This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637).
Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.
Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.
现金转移支付和代金券是“需求侧融资”的形式，在过去15年中已被广泛用于促进低收入和中等收入国家的孕产妇和新生儿健康。
本系统评价整合了七篇已发表的关于不同类型现金转移支付和代金券对孕产妇保健服务利用和质量影响的系统评价证据，并采用乔安娜·布里格斯研究所的系统评价方法将系统检索更新至2015年6月。本次更新的评价方案已在国际系统评价注册平台（PROSPERO）注册（注册号：CRD42015020637）。
来自51项研究（比之前的评价多15项）和22个现金转移支付及代金券项目的数据表明，与服务利用挂钩的方法（通过支付条件或特定服务的代金券）可以增加产前保健的利用、分娩时熟练助产人员的使用，就代金券而言，还可增加产后保健的利用。积极效果的最有力证据是有条件现金转移支付与产前保健的利用，以及孕产妇保健服务代金券和由熟练助产人员接生。然而，效果似乎受到一系列复杂的社会和医疗保健系统障碍及促进因素的影响。研究通常集中在项目初期，通常是启动后的两到三年，而且许多研究缺乏与供应侧投资的对照比较。几乎没有研究表明这些项目能提高孕产妇保健质量或改善孕产妇和新生儿健康结局。
未来的研究应使用多种干预措施来比较与公共服务类似投资的成本效益，并且应超越短期至中期的服务利用情况，通过考察项目成本、对服务利用和健康结局的长期影响以及这些影响的公平性。
