CCT for PMTCT Scale-Up

The Safe Motherhood Conditional Cash Transfer (CCT) Project was an ECEWS/New Incentives’ intervention aimed at preventing mother to child transmission of HIV by providing pregnant women with financial incentives and support to attend ante –natal clinics, go for HIV test, deliver with a skilled assistant and inoculate their children against early childhood illness. A total of 20 pregnant women from utra-poor households were identified and recruited in collaboration with the primary health care unit of the Uyo Local Government Area of Akwa Ibom state south-south Nigeria for the project. The project which was to consolidate on the gains of the pilot conditional cash transfer of vulnerable children and pregnant women also was to contribute to poverty alleviation, access to education, and health care for core poor families. The project was originally conceived to run for eighteen months. However, due to funding challenges, was reduced to only two months. The report here will capture the implementation of the project.

Recruitment of Participants:

A community sensitization was carried out February 4-8, 2013 at the Primary Health Care Centre, Uyo. At the meeting, participants were sensitized on the concept of the Safe Motherhood CCT Programme, conditions for recruitment of beneficiaries as well as for transfer and the life span of the project. Questions and other concerns from the participants were addressed.  The Primary Health Care Unit compiled the list of pregnant women from utra-poor households and submitted same foe assessment. A total 96 pregnant women took part in the sensitization and assessed for the intervention following which 31 women were selected. The selected women were further assessed at home to have a fair idea of their living condition. During this visit, the team was able to select 20 for immediate uptake on the project, recommended 9 women for the awaiting list and out rightly dropped additional 2 names from the list.  Beneficiaries were enrolled into the programme having met the selection criteria:

1. Income Level: (living below $2 a day, not gainfully employed,).
2. Susceptibility: (had a traditional birth attendant as a relative, child headed home, lived in a community setting more than 3 kilometres to the nearest health facility, and had previously been attended to by a traditional birth attendant).

• HIV Status: (PLHIV, living with a known PLHIV).

1. ANC Attendance/Trimester: (Had missed at least one ANC appointment, had up to 2 trimesters to be in programmes)
2. Most at Risk Populations: (sex worker, incarcerated population, street children, etc.)

Details of the project’s beneficiaries were as follows:

Analysis of the beneficiaries indicated that two were susceptible TBA delivery as they lived with relatives who were themselves traditional birth attendants. Eight beneficiaries lived in a community setting more than 3 kilometres to the nearest health facility, while another eight (8) had previously been attended to by a traditional birth attendant.  5 beneficiaries enrolled into the project were HIV positive, while four lived with relatives who were PLHIV.  ANC attendance review indicated the beneficiaries (10) had missed a least 1 ante-natal clinic attributing it to lack of transport fare and or lack of money to pay for medications.  Pregnant women who were dropped from the programme at the first instance were either employed, women with vocational trade who could take care of their needs and confessed to living at more than $2.00 per day or were married to men who could take care of their family. Of the thirty one women that were further assessed at home, (6) had their delivery due date in March 2013 while 5 pregnant women were married to men who were highly informed, professionals in their right, and capable of meeting their family needs.

Tracking of Conditions:

ECEWS/NEW Incentives developed sets of condition to track for through the 18 months that the Safe Motherhood Project was to run. ECEWS and the Primary Health Care Department, Uyo Local Government Area developed maintained a data base of the beneficiaries through which they were monitored. ANC appointments for all beneficiaries on the project were harmonized so that all beneficiaries attend clinic on the same date. ECEWS volunteers and staff monitored each clinic using a check list to track attendance and compliance with relevant conditions. The PHC department provided escorts to beneficiaries on referral for HTC, PMTC, birth certificates and immunization of children born to beneficiaries who were provided within the same health centre. New Incentives set up a Google spread sheet which it tracked conditions and transfers.

Cash Transfers:

Cash transfers (2) have been made to recipients on the project as follows:

Emem Mathew Etim (ANC No: 070/2013) defaulted from the conditions, delivered at home with a traditional birth attendant, and hence could not access the June 2013 cash transfer.

ANC Attendance and Skilled Deliveries:
All beneficiaries (20) achieved over 90% attendance at ante-natal clinic. Within the reporting period, a total of seven (8) beneficiaries delivered   with one (1) of them delivering with a traditional birth attendant. Details of the deliveries were as follows:

mfon-ezekiel-ekemini-signing-the-payment-voucher-for-her-transfer

eunice-edobong-with-her-baby

queen-emmanuel-ekpenyong

mfon-ezekiel-ekemini-with-her-baby

mary-justin-bassey-signing-to-collect-her-transfer

uniyime-with-her-baby-during-immunization-visit-transfer-collection

emem-daniel-udoh-with-her-baby

uniyime-victor-sunday-signing-a-pv-to-receive-her-transfer

eunice-elijah-edobong-signing-the-pv-for-her-transfer