Use of demand-side financing has become increasingly common in maternal healthcare and India has been a leading example with large-scale programmes such as the Janani Suraksha Yojana and Indira Gandhi Matritva Sahyog Yojana. This paper undertakes a systematic review of the evidence to consider how demand-side financing has been used and whether there has been any impact on maternal health service utilisation, maternal health, or other outcomes. The findings suggest that a relatively narrow focus on achieving targets has often overburdened health facilities, while inadequate referral systems and unethical practices present overwhelming barriers for women with obstetric complications. The limited evidence available also suggests that little has been done to challenge the low status of poor women at home and in the health system.

Background: Demand-side financing, where funds for specific services are channelled through, or to, prospective users, is now employed in health and education sectors in many low- and middle-income countries. This systematic review aimed to critically examine the evidence on application of this approach to promote maternal health in these settings. Five modes were considered: unconditional cash transfers, conditional cash transfers, short-term payments to offset costs of accessing maternity services, vouchers for maternity services, and vouchers for merit goods. We sought to assess the effects of these interventions on utilisation of maternity services and on maternal health outcomes and infant health, the situation of underprivileged women and the healthcare system.
Methods: The protocol aimed for collection and synthesis of a broad range of evidence from quantitative, qualitative and economic studies. Nineteen health and social policy databases, seven unpublished research databases and 27 websites were searched; with additional searches of Indian journals and websites. Studies were included if they examined demand-side financing interventions to increase consumption of services or goods intended to impact on maternal health, and met relevant quality criteria. Quality assessment, data extraction and analysis used Joanna Briggs Institute standardised tools and software. Outcomes of interest included maternal and infant mortality and morbidity, service utilisation, factors required for successful implementation, recipient and provider experiences, ethical issues, and cost-effectiveness. Findings on Effectiveness, Feasibility, Appropriateness and Meaningfulness were presented by narrative synthesis.
Results: Thirty-three quantitative studies, 46 qualitative studies, and four economic studies from 17 countries met the inclusion criteria. Evidence on unconditional cash transfers was scanty. Other demand-side financing modes were found to increase utilisation of maternal healthcare in the index pregnancy or uptake of related merit goods. Evidence of effects on maternal and infant mortality and morbidity outcomes was insufficient. Important implementation aspects include targeting and eligibility criteria, monitoring, respectful treatment of beneficiaries, suitable incentives for providers, quality of care and affordable referral systems.
Conclusions: Demand-side financing schemes can increase utilisation of maternity services, but attention must be paid to supply-side conditions, the fine-grain of implementation and sustainability. Comparative studies and research on health impact and cost-effectiveness are required.

Background The use of sets of indicators to assess progress has become commonplace in the global health arena. Exploratory research has suggested that indicators used for global monitoring purposes can play a role in national policy-making, however, the mechanisms through which this occurs are poorly understood. This article reports findings from two qualitative studies that aimed to explore national policy-makers' interpretation and use of indicators from country profiles and reports developed by Countdown to 2015.MethodsAn initial study aimed at exploring comprehension of Countdown data was conducted at the 2010 joint Women Deliver/Countdown conference. A second study was conducted at the 64th World Health Assembly in 2011, specifically targeting national policy-makers. Semi-structured interviews were carried out with 29 and 22 participants, respectively, at each event. Participants were asked about their understanding of specific graphs and indicators used or proposed for use in Countdown country profiles, and their perception of how such data can inform national policy-making. Responses were categorised using a framework analysis.ResultsRespondents in both studies acknowledged the importance of the profiles for tracking progress on key health indicators in and across countries, noting that they could be used to highlight changes in coverage, possible directions for future policy, for lobbying finance ministers to increase resources for health, and to stimulate competition between neighbouring or socioeconomically similar countries. However, some respondents raised questions about discrepancies between global estimates and data produced by national governments, and some struggled to understand the profile graphs shown in the absence of explanatory text. Some respondents reported that use of Countdown data in national policy-making was constrained by limited awareness of the initiative, insufficient detail in the country profiles to inform policy, and the absence of indicators felt to be more appropriate to their own country contexts.ConclusionsThe two studies emphasise the need for country consultations to ensure that national policy-makers understand how to interpret and use tools like the Countdown profile for planning purposes. They make clear the value of qualitative research for refining tools used to promote accountability, and the need for country level Countdown-like processes.

This discussion note provides a perspective on valuation studies by a group of PhD students. Based on impressions from the Valuation as Practice workshop at The University of Edinburgh in early 2014 we were inspired by the example of Kjellberg et al. (2013) to debate how we see, understand, and are inspired by the field of valuation studies. It is the hope of the editors that sharing the concerns of early-stage researchers starting out in a field in flux, may be of use to, and perhaps spur, senior contributors to further develop this emerging research landscape. Using the workshop experience as a springboard, we argue that the domain of valuation studies still relies heavily on influences from the study of economics, with a strong emphasis on processes of quantification and calculation. With apparent pragmatism within the field, concern as to what might be lost by this narrower perspective is raised. Additionally, we call for the exploration of the possibility of a common language of valuation, to better define shared features, and identify as well as manage conflicts within the field.

A dialogical conceptualisation of the self was originally developed in psychology by Hermans and colleagues (1992; Hermans, 2001) to provide an understanding of the self as multi-vocal and created in dialogue within the self and between the self and the other. Today, research in disciplines other than psychology has increasingly been influenced by this body of work. In particular, a strand of research analysing the dynamics of contemporary multicultural societies from a dialogical perspective is emerging (e.g. Bhatia and Ram, 2001; Harré and Moghaddam, 2003; Kinnvall and Lindén, 2010). Related to this work, a number of scholars are developing an approach to ethics where difference is seen as neither threatening nor abnormal but rather as a normal condition of being (e.g. Arnett, 2001; Nesbitt-Larking, 2009; Scuzzarello, 2009, 2010). Taken together, these studies point at possible linkages between psychology and politics, and they are good examples of what can be achieved within the framework of political psychology.