Monetary incentives are often used to increase the motivation and output of health service providers. However, the focus has generally been on frontline health service providers. Using a cluster randomized trial, we evaluate the effect of monetary incentives provided to community-based volunteers on early initiation of antenatal care visits and deliveries in health facilities in communities in Zambia. Monetary incentives were assigned to community-based volunteers in treatment sites, and payments were made for every woman referred or accompanied in the first trimester of pregnancy during January-June 2020. We found a significant increase of about thirty-two percentage points in the number of women seeking antenatal care visits in the first trimester but no effect on coverage rates (the percentage of women who deliver at a health facility and are assisted by skilled birth attendants). The number of women accompanied by community-based volunteers for antenatal care in the first trimester increased by thirty-three percentage points. Deliveries in health facilities also increased by twenty-two percentage points. These findings suggest that the use of health facilities during the first trimester of pregnancy can be improved by providing community-based volunteers with monetary incentives and that such incentives can also increase deliveries in health facilities, which are key to improving the survival of women and newborns.
