Assessing the Effect of Incentives to Encourage Facility-Based Delivery among Women at Grey Bush Health Facility in Sierra Leone

Abstract

Background: In Sierra Leone, maternal and infant death rates are still high. Despite the Free Health Care Initiative that offers to make health care services free, challenges due to a cultural preference for delivering at home and barriers of access to the health facility continue to persist. To promote deliveries in healthcare facilities the Mama-Pikin Foundation initiated an incentive program providing delivery kits and transportation allowances to women through the Grey Bush Community Health Centre. This study therefore sought to assess the effect of incentives to encourage facility-based delivery among women at Grey Bush health Facility in Sierra Leone Methods: A secondary analysis of health facility records of 5,198 women attending ANC at Grey Bush health facility in Sierra Leone was undertaken over a 14year period of 2010 to 2023. Descriptive analysis was used to report aggregated frequencies and percentages of the various categories of background factors as well as the key maternal health outcomes of supervised deliveries, antenatal care (ANC) contacts, maternal deaths, and home deliveries under investigation. An Interrupted Time Series (ITS) analysis was employed to compare the maternal health outcomes before and after program implementation to explore the intervention effect among women The coefficients for the intervention variable and interaction terms alongside the change levels and confidence intervals were reported to compare trends in pre and postintervention. All analysis was set at 95% confidence level. Results: The analysis revealed that home deliveries decreased substantially from 107.63 in 2017 to 99.49 per 100,000 live births in 2023. This represented a change of 8.14 per 100,000. Supervised deliveries increased from 13.71% before 2017 to 19.39% in 2023. At postintervention, an increase in ANC 4th contacts coverage of 4.04% (P <0.05) was observed. For the 8th ANC contacts, the results reveals a concerning decline over the years, with a sharp drop from 50% in 2017 to 26.82% in 2022. Although a decline in maternal deaths was recorded, the long-term effect was negligible. Conclusion:The incentive-based interventions lead to increased supervised delivery rates, increased ANC contact coverage and reduced maternal deaths. The Mama-Pikin Foundation’s approach presents a model for overcoming cultural and logistical obstacles to accessing healthcare in Sierra Leone. Similar incentive programs could be implemented in high-mortality districts, alongside an assessment of the long-term impact and generalizability of such interventions in resource constrained settings.