Monetary incentives are often used to increase the motivation and output of health service providers. However, the focus has generally been on frontline health service providers. Using a cluster randomized trial, we evaluate the effect of monetary incentives provided to community-based volunteers on early initiation of antenatal care (ANC) visits and deliveries in health facilities in communities in Zambia. Monetary incentives were assigned to community-based volunteers in treatment sites, and payments were made for every woman referred or accompanied in the first trimester of pregnancy during January–June 2020. We find a significant increase of about 32 percent in the number of women completing ANC visits in the first trimester but no effect on service coverage rates. The number of women accompanied by community-based volunteers for ANC in the first trimester increased by 33 percent. The number of deliveries in health facilities also increased by 22 percent. These findings suggest that the use of health facilities during the first trimester of pregnancy can be improved by providing community-based volunteers with monetary incentives and that such incentives can also increase deliveries in health facilities, which are key to improving the survival of women and newborns.

中文翻译：

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货币激励和早期启动产前保健：在赞比亚进行的配对、平行整群随机试验

货币激励通常用于提高卫生服务提供者的积极性和产出。然而，重点通常放在一线卫生服务提供者身上。通过一项整群随机试验，我们评估了向社区志愿者提供的货币激励对赞比亚社区医疗机构早期产前检查 (ANC) 就诊和分娩的影响。为治疗场所的社区志愿者分配了金钱奖励，并为 2020 年 1 月至 6 月期间在怀孕的前三个月转诊或陪同的每位妇女支付了款项。我们发现完成治疗的妇女人数显着增加了约 32% ANC 在头三个月就诊，但对服务覆盖率没有影响。在孕早期由社区志愿者陪同参加 ANC 的女性人数增加了 33%。医疗机构的分娩数量也增加了 22%。这些研究结果表明，可以通过向社区志愿者提供金钱奖励来改善怀孕头三个月对卫生设施的使用，并且此类奖励还可以增加卫生设施中的分娩，这是提高妇女和新生儿生存率的关键.