Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya

In an experimental setting in Kenya, we show that certain financial and informational interventions delivered over the mobile phone network can be highly effective in boosting facility delivery rates of poor, rural women. Vouchers covering the full cost of care increased facility delivery rates by one-third, but a small copayment reduced the effect to almost zero. Cash transfers sent over the mobile network and labeled as transport subsidies, had similarly large effects only if they were conditional on delivering in a facility. By contrast, unconditional transfers had no effect on health care utilization. In contrast, we find a government policy that simply made care free at the point of service had little effect on demand. JEL Codes: L10, D10, D04, O12 Highlights: • Full vouchers and conditional cash transfers were highly effective, and costeffective, at increasing rates of institutional deliveries among poor, rural women in Kenya. • Co-payments greater reduced the effectiveness of vouchers and unconditional transports were not effective. • A free care policy instituted by the government also demonstrated no effect on institutional deliveries. • SMS text reminders did not have any effect on institutional deliveries.