The SEI working paper series aims to expand and accelerate the availability of our research, stimulate discussion, and elicit feedback. SEI working papers are work in progress and typically contain preliminary research, analysis, findings, and recommendations. Many SEI working papers are drafts that will be subsequently revised for a refereed journal or book. Other papers share timely and innovative knowledge that we consider valuable and policy-relevant, but which may not be intended for later publication.

Background Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. Methods The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1 year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5–10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial’s primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. Discussion This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable context...

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A tiumber of rural household-based productive activities, such as kitchen gardens, livestock rearing and micro enterprises, are dependent on adequate supplies of domestic water to operate. This paper examines whether improved access to piped water can facilitate these types of activities, particularly for poor households. Usitig data from rural Vietnam, we find that most household enterprises use non-metered water and have very small profit margins. Thus, the evidence suggests that these enterprises may be better supported by a household-level water supply infrastructure, such as well pumps and rainwater catchment tanks, rather than by piped systems in rural areas. We also found an unanticipated link between operating small-scale food production businesses and raising livestock: for matiy households, waste products from food-based micro enterprises were used for rearing pigs, and this enabled business owners to expand their pork production, a significant source of income and prosperity in rural Vietnam.