Demand Side Financing (DSF) programs such as, CCT are usedto increase the access of health services. The defining character of such programs is that they establish the linkbetween the user of service, the underlying purpose or objective of the use,and the subsidy (Gupta, Joe, & Rudra, 2010). Such programs deliver monetary incentives tothe users to incentivize the use of specific health care service by reducingthe financial burden for such services (Bowser et al., 2016).
CCTprograms shift and increase the purchasing power in the hands of users who, inturn, make rational decisions to maximize their benefits and reduce theirlosses. As health service utilization isnot monolithic, multiple factors come into play. For example, the utilization is subject tothe availability of services and upon the presence of need (being pregnant)which leads to creation of demand for the service (Sugathan et al., 2001).
As demand overlaps the availability of healthservices actual utilization occurs as utilization is facilitated by improvedaccess. In the absence of suchfacilitation, women defer their health seeking behavior due to a number ofreasons which may range from: opportunity cost of accompanying person, somedeferred work at home ranging from cooking, fetching water, or simple lack ofempowerment, etc. Cash transfer programsmay operate at various interfaces by ensuring the availability of financialresources which can make money available for transportation to improvegeographic accessibility. They canimprove cash flow within the society thus improving affordability (Jacobs, Ir, Bigdeli, Annear, & Van Damme, 2011). The incentive in the form of cash transferraises the demand and subsequently improves the affordability of the women touse such services. Cash transfer improvesthe access of pregnant women and subsequently utilization of maternal services,as utilization is an operational proxy of the access.
Access which is timely use of services is multi-dimensionaland includes availability, geographic accessibility, affordability andacceptability (O’Donnell, 2007) (see Fig.1). The present study has used a framework built on factors identified by TimEnsor on demand side (Ensor & Cooper, 2004). All demand side factors which operate atmultiple levels and influence utilization behavior of healthcare buyer has beenused in the present analyses.