Launching Ceremony of the Monograph on Does More Money Mean Better Health?

The launching ceremony of the 11th monograph of the Center for Policy Research (CPR) of International University of Business Agriculture and Technology (IUBAT) on Does More Money Mean Better Health? Assessing the Maternal Allowance Program took place at 11:00 AM on Sunday, August 24, 2014 at the VIP Lounge of the National Press Club. The monograph was introduced by the author Mr Qayam Jetha, Visiting Fellow to CPR, IUBAT and Prof Dr John Richards, Professor of Public Policy at Simon Fraser University, Canada and Member of the International Advisory Council of IUBAT. Professor Dr M Alimullah Miyan, Founder Vice-Chancellor of IUBAT presided over the ceremony.

While introducing the monograph, the speakers stated that the Bangladesh Government introduced the Maternity Allowance Program (MAP) on a national basis in 2007. This program provides a Tk.350 monthly stipend for 24 months to low-income rural women expecting their first or second child.  Selection is made by Union Parishads based on several criteria. The program has several goals: reduce poor pregnancy outcomes, increase breastfeeding and knowledge about family planning, enhance maternal nutritional status, and increase the use of maternity-related services. Currently, each year over 100,000 mothers throughout rural Bangladesh become MAP beneficiaries.

Mr Qayam Jetha has evaluated the MAP in realizing its goals, based on a survey of 700 mothers in three Upazilas in the Lakshmipur district, whose babies were born between August 2011 and March 2012. The survey compared outcomes among 350 mothers who were MAP beneficiaries and 350 mothers, who were eligible but who did not become beneficiaries. The basic evaluation question to answer is, to what extent did the MAP beneficiary mothers experience better health outcomes than the mothers who did not receive the MAP.

The IUBAT Centre for Policy Research thanks the Development Organization of the Rural Poor (DORP) for facilitating the survey. However, the author undertook the study independently, and he is responsible for results. The results from a survey of MAP conducted elsewhere in Bangladesh may differ from those discovered in Lakshmipur.

Overall, the MAP clearly has generated benefits. To summarize:

· Impact on maternity services: The MAP has significant and substantial positive effects on whether a mother received antenatal and postnatal care. The MAP does not however influence the location of delivery and the choice of birthing attendant. Over 90 percent of births among the sampled women occurred at home.

·         Impact on women’s health education and nutrition: The MAP generated significant benefits. MAP beneficiaries were more aware of good health practices during pregnancy and the importance of breastfeeding. They made better use of vitamin and mineral supplements, and their diet was more varied than that of non-beneficiary mothers. Extent of breastfeeding was however similar in both groups.

·         Focus group results: In focus group discussions, beneficiaries stated that access to the monthly MAP benefit generally enhanced their family status.

·         Impact on maternal and child disease: MAP did not lower the incidence of diarrhea among MAP mothers and children. The incidence was similar among both beneficiaries and non-beneficiaries.

The author makes several recommendations to improve implementation of the MAP:

·         Send the MAP funds directly to union parishads: Presently mothers must visit the upazila office, which may require a lengthy trip by auto rickshaw or rickshaw.

·         Specify that the three union parishad women make the selection of MAP beneficiaries. This occurs frequently, and will probably lower the problem of potential corruption in selection. (In the focus groups some participants stated that the union parishad delegated selection to someone not a member, and that he demanded boksheesh from those selected. There were no such criticisms by beneficiaries who were selected by women members.)

·         Ensure that the first MAP payment is given prior to birth: Among the focus group members half stated they received their first payment after delivery.

·         Clarify and simplify the eligibility criteria: Many beneficiaries have estimated income higher than the specified maximum. The present maximum may be too low to be realistic.

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