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May 1, 2012
Every year, hundreds of thousands of women die during childbirth as a result of preventable conditions, including the fact that many couldn’t afford proper care. Starting later this fall, an 18-month research initiative in Kenya will deliver, via mobile phones, a set of interventions designed in part to help pregnant women set aside enough savings to cover the cost of skilled care and delivery assistance.
The research will be conducted by James Habyarimana and Billy Jack, both of Georgetown University, Tavneet Suri of MIT, and Karen Grépin, an assistant professor of global health policy at NYU’s Robert F. Wagner Graduate School of Public Service, in collaboration with Changamka, Ltd., a Kenya micro-savings company. Financial support for the project comes from the Microsavings and Payments Innovation Initiative at Yale University, Innovations for Poverty Action, and the Bill and Melinda Gates Foundation.
Professor Grépin, whose research work focuses on the economics and politics of health service delivery in developing countries, with a focus on sub-Saharan Africa, spoke with NYU Research Digest as she prepared to launch the project, and, as it happens, as she anticipated her own delivery too, in May. (A shorter version of this interview appeared in the Spring 2012 Digest.)
What’s driving the project? Pregnant women in many developing countries, including Kenya, say that financial barriers keep them from seeking proper maternal health services, including skilled assistance at delivery. What are the barriers to increased savings needed to cover the costs associated with delivery? That is the primary question we will attempt to answer.
Why is it important to know how and why pregnant women in Kenya save money? It’s important that we become better able to understand all the barriers that pregnant women face to health care – informational, financial, and others. If we do, we might be able to develop savings vehicles that would help promote the capacity of women to accrue enough money to cover the cost of their baby’s delivery, both in Kenya and other settings as well. Since we will also be able to learn what care these women seek for their deliveries, we hope that this study will also contribute to our understanding of health-seeking behavior.
Your project involves mobile phones. What is their significance here? One of the big innovations in this project is that we plan to deliver all of the interventions that we are testing (financial incentives and informational incentives) via mobile phones. Mobile phones have become widely available in many developing countries. But people don’t use them just for communication; they are also used as credit cards and bank accounts, especially in Kenya. If we find that our interventions are successful, the interventions can be scaled up rapidly and inexpensively due to the availability of this technological platform.
What unique challenges do you anticipate? Our primary research site will be in densely populated urban slums in Kenya. Since we need to track and monitor women for approximately a year, this can be challenging in these communities. Fortunately, we do have their cell phone numbers, which does make continued tracking a great deal easier!
How does this research relate to other work that has been done in this vein? This work is part of a growing area of research on the potential of m-health technologies to improve health service delivery in developing countries. It also adds to the growing literature in the international health economics literature on savings and incentives for seeking care. It is one of the few m-health programs under way that will be evaluated in a rigorous randomized control trial setting.
Why do you consider the project of great importance, and to whom? The work is critically important. Although great efforts have been exerted over the past few decades to improve access to maternal health services in most developing countries, millions of women still do not seek proper care at delivery, and as a result hundreds of thousands die every year during childbirth from conditions that could be prevented if they were access the proper care. Given that financial barriers are seen as key to this challenge, we hope that this work will help develop our understanding in this area.
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