Conditional cash transfers (CCTs) are a common tool used by governments to alleviate poverty. It involves direct cash transfers to individuals or households to help families manage expenses. In exchange for these grants, there are stipulations of required health check-ups or testing, educational enrollment or other factors that can broadly reduce poverty and improve standards of living.

Based on current evidence, CCTs are most effective in health care-related initiatives, often improving health outcomes and encouraging increased utilization of health care offerings. The studies that provide this evidence also note that despite the clear positive impact, the efficacy of these initiatives remains ill-defined. This is due to disparate health care systems and the quality of services offered between the countries and communities where CCTs have been implemented.

Maternal Mortality in the KP Region

In Pakistan and in South Asia generally, the maternal mortality rate is significantly high. Although there has been a significant drop in the maternal mortality rate of around 60% between 2000 and 2017, the region still accounts for around 20% of maternal deaths worldwide. The 2006-07 Pakistan Demographic and Health Survey was the first effort to collect information on maternal mortality in the country.

The survey revealed that during those years, there were 276 maternal deaths for every 100,000 live births in Pakistan. In 2007-08, in the Khyber Pakhtunkhwa (KP) region, the maternal mortality rate was 275 deaths for every 100,000 live births in the region. These numbers indicated severe deficiencies in the delivery of adequate health care to expectant mothers, which the local governments of Pakistan sought to address.

The Chief Minister’s Special Initiatives

In the KP region of Pakistan, the Chief Minister’s Special Initiatives are a set of poverty alleviation measures created by the local government. These initiatives aim to improve living standards by offering financial incentives to individuals who take advantage of local services focused on education, employment and health outcomes.

For example, grants were provided to female students above grade 5 to encourage them to continue their education. Stipends were also offered to young people enrolled in government-sponsored vocational training programs. These incentives were significant because they represented key examples of CCTs used as a poverty alleviation tool in Pakistan.

In 2014, recognizing the urgent need to address maternal mortality rates and in line with a national push to improve health care for mothers and children, the government of KP launched the Chief Minister’s Special Initiative for Mother and Child Health. This conditional cash transfer program provides fixed cash stipends to marginalized mothers for attending prenatal checkups, delivering safely and completing postnatal visits.

A 2024 study evaluating the program found a substantial increase in the total number of health-seeking hospital visits, indicating that the intervention successfully achieved its intended behavioral change. Additionally, the cash incentives improved household purchasing power and supported the incomes of vulnerable families. The findings provided strong evidence for expanding the use of other CCT programs in Pakistan.

Maternal Mortality Declines in KP

In the years that followed, the maternal mortality rate declined significantly. The 2019 Pakistan Maternal Mortality Survey collected updated national and regional data, showing trends since the 2007 survey. Nationally, maternal deaths fell from 276 to 186 per 100,000 live births.

In the KP region, the figure dropped from 275 to 165, representing a slightly higher percentage reduction than the national average. This suggests that local initiatives and conditions, including the CCT programs, may have contributed to reducing maternal mortality rates.

Final Remarks

The conditional cash transfers program in the KP region has already shown promising results for improving maternal health outcomes and alleviating poverty. It could be a model for the rest of Pakistan to follow and bring down its alarming maternal mortality rates.

– Nikhil N Kumar

Nikhil is based in Lexington, MA, USA and focuses on Global Health and Politics for The Borgen Project.

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