Excellence Community Education Welfare Scheme (ECEWS) with funding support from the New Incentive, USA is implementing a Conditional Cash Transfer (CCT) Project in Akwa Ibom State, Nigeria; to alleviate poverty by increasing access to education, and health care for ultra-poor families. Vulnerable children (13) and pregnant women (13) from ultra-poor households were targeted for the pilot project which ran September to December 2012.
Akwa Ibom State though an oil producing state in the South-South Nigeria has 58% of her population living in poverty with 28 % classified as ‘core-poor’. In the 2010 HIV Sero prevalence Sentinel Survey in Nigeria, Akwa Ibom state ranked second with 10.9% prevalence, even as only 9% of women in the state patronise PMTC services. The ECEWS/New Incentives’ conditional cash transfer programme came to enable poor individuals make better decisions, break the poverty cycle for individuals and their families, and contribute to efforts at realizing an AIDS free generation. Under this pilot, 13 pregnant women from ultra-poor families, who otherwise would not have delivered under skilled assistance were identified and enrolled into the programme to ensure that they received appropriate health care attention, and deliver under skill assistance as a measure to prevent mother to child transmission of HIV and also contribute to effort at reducing maternal and child mortality.
Vulnerable Children (VC) were assessed using child status index (CSI) tool, which allows for the grading of the vulnerable children and their needs. Officials of the Ministry of Women Affairs and Social Welfare, and community development committees were involved in the identification and selection process to ensure that children in most need were selected in the community. For the pregnant women, the community development committee, Primary Health Care Unit of the Local Government Area and ECEWS Project Team were involved in the identification and selection of ultra-poor pregnant women for the project. Family income, educational level, distances to nearest health facility, and history of unskilled labour was assessed in selecting clients.
1. Vulnerable Children 13
2. Pregnant Women 13
As part of effort at ensuring ownership and sustainability of the project beyond the pilot lifespan, ECEWS collaborated with relevant government agencies, community leaders and CBOs to implement the programme. The vulnerable children intervention leveraged significantly from the PEPFAR/CDC funded Orphans and Vulnerable Children Program of ECEWS in signposting to eligible children, Social Welfare Officers from the Ministry for Women Affairs and Social Welfare were involved in the administration of CSI tool on the would-be beneficiaries, Community development committees and Uyo Local Government Council gave the project their fullest support and participated in joint monitoring and transfers disbursements.
Transfers were made to 11 beneficiaries in the first month, 13 beneficiaries in the second and third months respectively for a total of thirty seven (37) transfers to vulnerable children. Transfers were made on condition that vulnerable children had at least 80% school attendance in school. ECEWS took great care to ensure that, transfers for vulnerable children were family centred to guard against stigmatization and promote a sense of responsibility among guardians. Vulnerable children transfers were most challenging as beneficiaries were spread across (5 local government areas of Eket, Mbo, Nsit Atai, Onna, and Uyo) and in most cases, difficult to reach communities.
Pregnant women in the programme (13) were billed to receive their transfers in three instalments (monthly) each for a total of $10.15 per beneficiary. Transfers were predicated on fulfilling certain obligations including attending ante-natal clinic, following instructions given as part of ANC, HIV testing and counselling, and delivery under skilled health assistance. Pregnant women in their 3rd trimester were prioritized for this pilot. 4 pregnant women delivered within the pilot period and accordingly, their conditions were immediately changed (to cover appropriate immunizations for the children), to ensure that the children got appropriate vaccination. Under the pilot, thirteen women received transfers in the first month, ten (10) in the second and third months respectively. This was because three (3) clients defaulted on the conditions for varied reasons in the second and four (4) in third months of the programme. One new client was however admitted into the programme within this period at the instance of the health facility to save the life of the woman and her child. See below the details of transfers.
13 Vulnerable Children for 3 months
14 Beneficiaries paid for 3 months
Monthly monitoring visits were made to schools to attended by beneficiaries and primary health care centre (PHC) to ensure that clients were adhering to their respective award conditions ( 80% school attendance for vulnerable children and routine attendance at ante-natal clinics for pregnant women) . We lost 2 vulnerable children, 1 to death and the other relocated relocated to Cameroun to join an uncle. Accordingly, two vulnerable children on ECEWS awaiting list were assessed and enrolled. There were two newly enrolled vulnerable children and among the pregnant women in the programme, one relocated to another state due to an employment she got with the Nigerian Police Force, and 3 defaulted on the award condition. 1 was referred for hospital care due to the lie of the baby- anterior located placenta. A new client was also up taken in December 2012 to provide a lifeline for her to access medication, transport to health facilities and dedicated care.
- We learnt through this programme that poverty is real with so many people unable to meet basic life’s needs.
- Money is a strong incentives and influences decision people make.
- Financial support to households could scale up the number of pregnant women who deliver with skilled assistant, and reduce maternal and child mortality. In our experience, there is a gap in the number and proximity of functional health facilities. In some areas certain means of transport (tricycle and motor bikes) are not allowed. Most health facilities don’t have functional ambulance, and on event of labour at night, one may not have access to ambulance and hence would need to hire a cab (between $3 to $7) to get to the health facility.
- Conditional Cash transfer could be an important tool for achieving AIDS free generation. We had a situation where one of the beneficiaries did not present a child for immunization, but on knowing that for her to receive the next transfer, evidence of the child’s immunization would be required, she quickly changed her mind and immunized the child.