JMIR Publications

ABSTRACT

Background:

Financial barriers to accessing obstetric care persist in many low-resource settings. With increasing usage of mobile phones, mobile money services appear as promising tool to address this concern. Maternal healthcare is particularly suitable for a savings program using mobile money due to the predictable timing and costs of delivery. The mobile money-based Mobile Maternal Health Wallet (MMHW) intervention aimed to ease the burden of out-of-pocket expenses related to maternal healthcare by providing an accessible savings tool.

Objective:

To assess the impact of the MMHW on maternal and neonatal health outcomes.

Methods:

We used a stratified cluster-randomized trial to assess the impact of the MMHW on maternal and neonatal health outcomes in the Analamanga region of Madagascar. All 63 eligible public-sector primary-care health facilities (Centres de Santé de Base, CSBs) within 6 strata were randomized to either receive the intervention or not. We estimated intention-to-treat effects and contamination-adjusted effects following an instrumental variable approach. The primary outcomes included (i) delivery at a health facility, (ii) antenatal care visits, (iii) total healthcare expenditure. Between March and December 2022, 6483 women who had been pregnant between July 2020 and December 2021 were surveyed.

Results:

Among women in catchment areas of treated CSBs, 39% had heard of the MMHW and 37% of those registered for the tool. There was considerable variation in take-up across treated CSBs. Descriptively, women in the catchment of treated CSBs were more likely to deliver in a facility, had more ANC visits and higher total expenditure for health compared to women in control CSB catchment areas in the intention-to-treat and the contamination-adjusted analysis. However, none of the effects were statistically significant.

Conclusions:

While this study did not identify statistically significant impact, the estimated contamination-adjusted effects suggest that the MMHW carries potential to improve access to maternal care for women who are receptive to such a mobile money-based savings tool. Estimated population-level effects were much smaller and this study was underpowered to detect such effects due to lower than anticipated take-up of the intervention. Clinical Trial: This trial was registered with Deutsches Register Klinischer Studien (German Clinical Trials Register), identifier: DRKS00014928.