Article Text

Download PDFPDF

Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya
  1. Neha Batura1,
  2. Jolene Skordis1,
  3. Tom Palmer1,
  4. Aloyce Odiambo2,
  5. Andrew Copas1,
  6. Fedra Vanhuyse3,
  7. Sarah Dickin3,
  8. Alie Eleveld2,
  9. Alex Mwaki2,
  10. Caroline Ochieng3,
  11. Hassan Haghparast-Bidgoli1
  1. 1Institute for Global Health, University College London, London, UK
  2. 2Safe Water and AIDS Project, Kisumu, Kenya
  3. 3Stockholm Environment Institute, Stockholm, Sweden
  1. Correspondence to Dr Neha Batura; n.batura{at}


Introduction A wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.

Methods and analysis The economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.

Ethics and dissemination The study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.

Trial registration number NCT03021070

  • cost effectiveness analysis
  • economic evaluation
  • priority setting
  • conditional cash transfers
  • maternal and child health
  • antenatal care
  • facility delivery
  • postnatal care
  • child immunization

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @nehabat, @JSkordis, @HHaghparast

  • Contributors NB, HH-B, TP, AC, FV, AE, AM, CO and JS contributed to the study design. NB, HH-B, TP, AC and JS contributed to the analyses. NB, HH-B, TP, AO, SD and FV contributed to data collection and acquisition. NB was responsible for the initial drafting of this manuscript, and all authors contributed to the review of this manuscript and provided comments. All authors read and approved the final manuscript.

  • Funding The study is funded by the Bill and Melinda Gates Foundation, Funding ID OPP1142564.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.