For nearly 50 years, Concern Worldwide has worked with the world’s poorest people to transform their lives. We reach 7.4 million people in 29 countries, working in emergency response, health and nutrition, climate resilience and more. Innovations for Maternal, Newborn & Child Health, an initiative of Concern Worldwide U.S., pilots creative solutions for improving the survival and health of women, babies and children. Innovations is supported by the Bill & Melinda Gates Foundation.

for maternal, newborn& child health

COMMUNITY BENEFITS HEALTHIncentivizing Communities in Ghana to Support Women’s Health Care

Community Benefits Health is a pilot project in Ghana’s Upper West Region that creatively uses non-monetary incentives to cultivate communities’ commitment to improving maternal, newborn and child health (MNCH).

The program targets Ghana’s rural communities that have among the country’s highest death rates for pregnant women and newborns. Community Benefits Health aims to improve healthy behaviors through robust health messaging that targets women and the important influencers in their lives – such as husbands, mothers-in law and village elders – in complement with an incentive that benefits the entire community.

The program aims to make four antenatal care visits, facility delivery, a post-delivery check for mother and baby and early exclusive breastfeeding the community social norm.

ABOUT COMMUNITY BENEFITS HEALTH

The Program

The Ghana Health Service has identified as a high priority the need to increase the number of women accessing MNCH services. Yet many factors, including cultural barriers, prevent women from seeking care. In the communities targeted by CBH, common practices include not disclosing a pregnancy for months, visiting a traditional healer instead of a health worker throughout pregnancy and delivering without a skilled attendant. Importantly, the decision makers in a woman’s life, such as her husband, may want her to continue these traditions and dissuade her from seeking skilled care.

Community Benefits Health targets not just the women but the key influencers in their lives with education and messaging related to healthier pregnancies, childbirth and newborn

care. Outreach includes radio programming, dramas and popular videos that community members perform in and that are well attended at festive events; trained peer educators who reach out to groups of women, husbands and community leaders for tailored discussions on improving health; and durbars, or village meetings, where community health officers share health information, including the importance of male involvement.

ProNet North, a Ghanaian sustainable development organization, is implementing the program in three districts in Ghana’s Upper West Region: Lambussie-Karni, Wa West and Jirapa. JSI Research & Training Institute Inc. and Kintampo Health Research Centre provide research, monitoring and evaluation to measure the program’s effectiveness.

Community Incentive

A non-financial incentive plays a key role in CBH. Unlike other health programs that use individual incentives, such as paying a pregnant woman with cash, Community Benefits Health engaged the communities to choose an incentive that benefits all. Most villages chose a borehole to provide water, as women travel far to collect water daily, and two chose an emergency vehicle known

Community Engaged in Program Design

To build ownership, CBH used a technique called human-centered design in which participating communities helped design the program and chose the incentives. Community governance committees comprised of prominent elders carry out the program, decide which targets the community must meet and ensure that everyone participates.

Program Successes

Since the pilot began in 2014, CBH has already shown progress, including improved health knowledge and health-seeking behaviors. Women are going to facilities for early antenatal care, delivery and postnatal care. They’re practicing exclusive breastfeeding and have come to understand that its early initiation is making their children healthier. There is growing involvement and support among men, including chiefs and husbands, for skilled care with husbands accompanying their wives to the health center.

as an emergency transport system, for getting women with complications and others in need to the hospital. The incentives are awarded in three stages as targets related to health behaviors are met. By incentivizing change, the CBH program aims to reduce resistance to health-seeking behaviors and to encourage uptake of services, ultimately changing social norms.

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