BMC Public Health. 2025 Dec 24;25(1):4300. doi: 10.1186/s12889-025-25632-6.
ABSTRACT
BACKGROUND: Antenatal care (ANC) is essential for maternal and newborn health, yet its utilization and quality remain suboptimal in many low-income settings. Evidence on the effectiveness of non-financial incentives to improve ANC is limited. This study examined the effect of a performance-based non-financial incentive (PBNI) intervention on the quality and optimal utilization of ANC in northwestern Ethiopia.
METHODS: A quasi-experimental pre-post study with a comparator group was conducted in 2020-2021 involving 1,927 women. The intervention provided non-financial incentives such as smartphones, power banks, scholarships, and certificates, which were distributed at the facility, departmental, and individual levels. Incentives were tied to the performance of the Routine Health Information System(RHIS), focusing on data quality and utilization, including maternal care indicators among the evaluation criteria. Quality ANC was defined as receiving at least 8 of 9 essential components, while optimal ANC was defined as having four or more visits, in accordance with 2020-2021 national guidelines. The analysis used difference-in-differences robust Poisson regression, reporting incidence rate ratios (IRRs) with 95% confidence intervals.
RESULTS: The study revealed a significant 1.44-fold improvement in ANC quality through a PBNI (IRR = 1.44, 95% CI [1.07-1.96]). However, no statistically significant association was found for optimal ANC (IRR = 0.85, 95% CI [0.68, 1.05]). The adjusted analysis identified rural residence (IRR = 1.43, 95% CI [1.12, 1.83]), husbands with primary education (IRR = 1.30, 95% CI [1.09, 1.55]), and birth intervals of 24 to 33 months (IRR = 1.59, 95% CI [1.16, 2.19]) as factors associated with quality ANC. Besides, women with higher education (IRR = 1.98, 95% CI [1.55, 2.52]), engagement in housework (IRR = 0.63, 95% CI [0.52, 0.77]), and awareness of at least two danger signs (IRR = 1.15, 95% CI [1.02, 1.29]) were linked to optimal ANC.
CONCLUSION: PBNI significantly enhances ANC quality but lacks statistical significance for optimal utilization. PBNI can motivate providers and enhance service quality when integrated with RHIS-strengthening efforts; however, longer implementation and complementary demand-side strategies may be necessary for sustained optimal ANC improvements.
PMID:41444879 | DOI:10.1186/s12889-025-25632-6
