Impact Evaluation of Maternity Allowance Program in Bangladesh
Introduction and Objectives
The main purpose of the present evaluation is to assess the effect of the program intervention and to examine the impact of the program on the beneficiaries. The present research has been carried out based on a survey of 420 beneficiaries of Maternity Allowance Program and 196 non-beneficiaries. The survey was conducted in 7 divisions of the country. From each division, the sample locations consisted of one district, two upazilas and four unions. The main purpose of the study is to assess the impact of the program on VGD beneficiaries in reducing poverty and in enhancing income and livelihood patterns of program beneficiaries.
A total of 420 beneficiaries were selected from the 28 sample unions (15 beneficiaries from each union). The control group for the present survey was selected in such a way that the non-beneficiaries belong to similar socio-economic category as that of the program beneficiaries, but having no involvement with the allowance program. From each selected union, 7 control households were selected which gave a total of 196 non-beneficiaries from 28 sample unions.
Key Findings
Household income is an important indicator of poverty. Our findings suggest that a significant majority of beneficiary households have been able to increase household income after participation in the program. The monthly income of beneficiary households was found to be 30 per cent higher compared to non-beneficiary households (TK. 3971 vs Tk. 3060). This implies that in terms of income poverty, beneficiary households are much better off compared to non-beneficiary households.
Again, the income of the beneficiary households has increased by 46 per cent after participation in the program (from Tk. 2713 to Tk. 3971). The overall poverty situation seems to have improved significantly after joining the program. It appears that more than one-third (36%) of the beneficiary households used to earn a monthly income not exceeding Tk. 2000 before joining the program, the corresponding figure at the time of the survey was only 3.1 per cent. On the other hand, only 2.4 per cent of the beneficiary households had monthly income exceeding Tk. 5000 before joining the program, but this proportion has gone up to 15 per cent after participation. The impact of the program in enhancing household income is clearly reflected through the changes in household income before and after participation which contributed to improvement in nutritional situation of beneficiary households.
In terms of monthly income, year round food security and housing conditions, the beneficiary households are much better off compared to their non-beneficiary counterparts. Though a significant proportion of beneficiary households still have low incomes, live in poor housing conditions and suffer from food inadequacy for several months in a year, but compared to their non-beneficiary counterparts, their vulnerability has been reduced to a large extent and there has been reasonable improvement in their poverty situation.
Respondents were also asked whether they knew about their monthly entitlement under the allowance program. More than three-fourths of the beneficiary women said that they are aware of their monthly allowance ( i.e. Tk. 350 per month). A similar proportion of the respondents (88.1%) also maintained that they also got their actual entitlement as allowance money. However, around 12 per cent of the beneficiaries complained that occasionally a small deduction was made from their monthly allowance (ranging between Tk. 10 to 20), but that was also not on a regular basis.
Beneficiary women were asked about their control over the allowance money. An overwhelming majority of them (69.6%) said that they could always spend the money according to their need, about a fourth (27.4%) of them could do so occasionally, while 3.1 per cent of the beneficiaries could never spend the money according to their desire.
Of the women who could not spend the money according to their own choice, a vast majority of them (80.47%) said that their husbands used to take away the money for spending by himself, 14.84 per cent of the women said that their husbands used to dictate how and where to spend the money, and the remaining 5 per cent said that the money was spent on other essential household items.
Summary Findings from Focus Group Discussions (FGD)
Several focus group discussions have been conducted with the local leaders, including school teachers, NGO workers, religious leaders, shopkeepers, UP members, etc.
To identify whether the selection of women into the program at the local level was fair, we checked if the women selected were eligible, whether they had to pay any fee/bribe to obtain the card, or if they had to lobby with local level leaders –UP member, chairman etc.
Most of the FGD participants were of the opinion that in some cases aspiring woman had to spend some money for being included in the list of beneficiaries – and on the average they spend around Tk. 500 for getting a card. However, once they got the card, they did not have to pay any money to receive the monthly allowance from the bank. It emerged from the discussion that some of the really deserving and eligible women were not selected because they were unable to pay the money demanded by the selection committee/local level leaders as bribe, and as a result they were excluded from being selected. The FGD participants maintain: “the proportion of such beneficiaries who had to make extra payment was not large- on the average around 10 per cent of the cardholders made such payments”.
“Regarding their entitlement, most of the beneficiaries know about the exact amount they are supposed to receive under the program and they also received the allowance as per their entitlement” as mentioned by most of the FGD participants.
According to majority of the FGD participants, the selection process was fair, although a small minority of the FGD participants thought that it was unfair, mainly because some of the very poor women have been excluded from the program. In general, the consensus was that poor women had been selected to participate in the program even though there were a lot of other women who were equally poor but were not covered under the program because of shortage of cards.
The FGD participants think that although in the majority of cases, the Union Parishad chairperson and the selection committee were involved in preparing the beneficiary list; they reported that sometimes local level political leaders (i.e supporters of ruling party) try to influence the selection process.
“In general, extremely poor women got the cards during their last pregnancy, even though some of the equally poor pregnant women were deprived. Poor women who are not connected to the local elites are more likely to be excluded from getting the card”- this was the general perception held by the local people. Broad-based participation of local people and formation of selection committee with neutral people will go a long way in ensuring transparency in the selection process.
It has been found by the present evaluation that maternity allowance program under the Government initiative has been effective in increasing knowledge and practice regarding RH and child care related issues. The main success of the program lies in the fact that the beneficiaries possess better knowledge in RH related issues and are also practicing their acquired knowledge in their day to day life. The findings reveal that the maternity allowance program has positive impact on use of ANC/PNC, food consumption during pregnancy, accompanied by better health and hygienic practices.
Economic empowerment leads to social empowerment since social insecurity is often seen as resulting from economic deprivation. Awareness building has been one of the impacts of the program. Lifestyle has shown positive changes in that the use of ANC/PNC has gone up including intake of nutritious food during pregnancy and lactation. People are empowered now and are aware of the surrounding environment more than before. However, inadequate coverage/limited number of beneficiaries is the major problem of the program and as such efforts should be made by the government to increase the number of beneficiaries through allocating more resources.
Concluding Remarks
In order to bring desirable improvement in the maternal health status and to achieve the MDG goal of reducing maternal mortality ratio to 143 by 2015, the government has undertaken various measures including the ‘maternity allowance program’ to help the poor women. Such allowance is targeted to the poor and vulnerable pregnant women who belong to functionally landless households having only homestead land (without any cultivable land); with low and irregular income not exceeding Tk.1500 per month, and women who lack productive assets.
The Program was officially launched in July 2007 in 3000 unions throughout the country, and 15 selected pregnant women from each union used to receive Tk.300 per month under this Program. Subsequently, the Program underwent few changes; monthly allowance was raised to Tk.350 in July 2009, and the Program was expanded to 4508 unions in 2011-12. Currently, there are 101,200 beneficiaries of maternity allowance program and once a woman is selected for this allowance, she receives benefit for two years. This is a countrywide Program and currently covers all 64 districts, 484 Upa-zilas, and 4508 unions. One woman can receive such benefit only once during her lifetime.
The maternity allowance program has as its target the improvement of nutritional status and healthy practices during pregnancy, at the time of delivery and after child birth. The initiative promotes action on four fronts: (1) redressing the socio-economic inequities confronting women; (2) ensuring that pregnant women from the poorest strata of life have access to adequate health care and nutrition during pregnancy and after delivery; (3) providing cash benefit for better maternity care, so that women are able to proceed smoothly during pregnancy, delivery and the postpartum period; and (4) providing information about back-up and support services, raising awareness about special care during pregnancy and lactation, that means improving the availability, quality and acceptability of RH services.
The Allowance Program focuses on the social, economic and cultural factors that influence reproductive health. This package includes safe motherhood, family planning, child survival and development, control of sexually transmitted diseases, and raising awareness of the woman and the community about special needs during pregnancy and lactation. The efficient targeting and fullest exploitation of maternity allowance program should bring about a dramatic improvement in the health status of poorest mothers.
This program has been successful in addressing the poverty situation of the beneficiary women. Because of the allowance money, the situation with regard to food and nutrition has improved significantly even after the end of the project benefit. The main success of the program lies in the fact that the beneficiary women have been able to improve their socio-economic condition with positive impact on income, food consumption and better access to ANC and PNC. In addition, there have been favourable changes in the quality of life of the beneficiaries as reflected through better access to health care and healthy and hygienic practices during pregnancy and lactation, more awareness regarding importance of nutritious food and better child care practices.
Inadequate coverage of beneficiary is a serious weakness of the maternity allowance program. It was observed that many eligible poor women who meet all the eligible criteria have been left out of the program mainly because of the limited number of beneficiaries covered by the program and inadequate funding situation. Findings of the present study (including FGD) reveal that in terms of almost all the poverty indicators, the non-beneficiaries are as poor as the beneficiaries are. A large majority of our respondents (both beneficiaries and non- beneficiaries) maintain that the number of beneficiaries should be at least double than that of the present size.
For improving the health of poor pregnant women, a combination of the following is necessary:
1) Need based adequate nutrition for pregnant and lactating women and their children.
2) To educate women and prepare them for a healthy pregnancy and safe delivery.
3) Arranging long-term training for the health providers including TBA/Dai to ensure quality services for safe motherhood.
4) Community mobilization i.e. raising of community awareness regarding special needs during pregnancy, and providing women with adequate food and nutrition.
Under the recently introduced Maternity Allowance Program due emphasis is given on the above issues. However, with regard to (3) above, no concrete measure has been taken as yet. This should be done on a priority basis.
For health and well-being of pregnant and lactation of women, the following are important:
• prenatal medical care – immunization of pregnant mothers and proper treatment of infections during pregnancy and puerperium should reach all mothers;
• prenatal non-medical care, maintenance of maternal health including nutrition during pregnancy and lactation should be ensured;
• medical care at the birth of the child-safe delivery and general hygiene including the use of sterilized instruments to cut the umbilical cord
Recommendations
On the basis of quantitative and qualitative data, the following recommendations can be made:
• The formation of selection committee is sometimes politically biased, which results in miss targeting of beneficiaries.
• It has been observed that the selection committee has to face tremendous political pressure in preparing the list of potential beneficiaries, especially so in areas where the local government representatives i.e. chairman/members are supporters of opposition political party.
• The process involved in preparing the preliminary list of beneficiaries is not transparent enough, and sometimes the members of selection committee use their discretion ignoring the selection criteria. Thus the most deserving, poor and destitute women run the risk of being deprived and excluded from the list.
• The chances of being included in the preliminary list primarily depend on the impression of the local level leaders/selection committee, and in the process, the poorest of the poor and the neediest, may be excluded. For effective implementation of the program it is important to strictly follow the selection criteria and lessen political pressure.
• There have been complaints of bribery in the process of selection of beneficiaries. During the field survey the enumerators have come across with people who had to pay money for being included in the beneficiary list. This has also been confirmed by the FGD participants. However, the extent of bribing varies from Tk. 70 to Tk. 2,500.
• There is lack of proper monitoring by MOWCA/DWA in the implementation process, mainly because of shortage of man power. This needs to be addressed urgently for smooth functioning and proper monitoring. There should be regular mechanism of monitoring the cash benefit distribution process periodically.