The effect of supply-side conditional cash transfers on healthcare outcomes for women and children: evidence from experimental and observational data

We evaluate the short- and long-term impacts of a supply-side conditional cash transfer (SS-CCT) program that incentivized healthcare providers to increase the delivery of essential maternal and child health services in Afghanistan. Leveraging data from a randomized controlled trial conducted between 2010 and 2013 and nationally representative household surveys from 2013 to 2018, we estimate causal effects during the implementation period and after program termination. Short-term impacts are identified using two-stage least squares (2SLS), instrumenting actual service receipt with randomized facility assignment. Long-term effects are estimated using a multilevel random effects model that exploits variation in historical exposure to the SS-CCT program. Results show that the intervention significantly increased antenatal care visits, institutional deliveries, and child immunizations in the short run, with larger gains among women with formal education and households in higher wealth quintiles. After the program ended, these gains diminished for most preventive services but persisted for institutional deliveries. Supplementary analyses suggest that sustained provider motivation and facility quality are critical to maintaining long-term impacts. These findings highlight both the potential and fragility of SS-CCT programs in resource-constrained environments like Afghanistan.