Impact of the Aama Programme on Institutional Delivery in Nepal
Suresh Mehata, Yuba Raj Paudel, Maureen Dariang
Journal of Nepal Health Research Council · 2017
Countries: Nepal
What Was Studied
This quasi-experimental study evaluated the impact of Nepal's Aama programme, which provides cash incentives to women for delivering at health facilities and free delivery services, on institutional delivery rates across 15 districts between 2005 and 2014.
What They Found
Institutional delivery rates increased from 18% to 55% in programme districts over the study period. The cash incentive component was particularly effective in remote districts where transport costs are a major barrier. However, quality of care at facilities did not improve proportionally — the programme increased access but did not address clinical quality. Wealthier women benefited more than the poorest, suggesting the programme alone was insufficient to close equity gaps.
What This Means for Nepal
The Aama programme successfully increased facility deliveries but the equity gap persists. Nepal needs to complement demand-side incentives with supply-side quality improvements — more skilled birth attendants, better-equipped facilities, and stronger referral systems. The programme design should be revised to provide higher incentives for the poorest quintiles and most remote areas. Integration with the Social Health Insurance scheme could improve sustainability.
Contextualisation
The Aama (Mother) programme is Nepal's flagship demand-side financing initiative for maternal health. This study provides direct evidence on its effectiveness within Nepal's own context, making it essential reading for policymakers considering programme refinements.