Health Policy 77 (2006) 221–232 Evaluating program effects on institutional delivery in Peru Michael J. McQuestion a,∗ , Anibal Velasquez b a Johns Hopkins Bloomberg School of Public Health, Population and Family Health Sciences, 615 N Wolfe Street, E-4142, Baltimore, MD 21205, USA b Consultant, PHRPlus, Antequera 777 Piso 8, San Isidro, Lima, Peru Abstract We evaluate the joint effects of two targeted Peruvian health programs on a mother’s choice of whether to deliver in a public emergency obstetric care (EmOC) facility. The national maternal and child health insurance, or SMI Program, provided delivery care coverage to Peru’s poorest households beginning in 1998. During 1996–2002, Proyecto 2000 sought to improve the quality of EmOC and increase utilization of public EmOC facilities in the districts reporting the highest maternal and neonatal mortality levels. Our data come from the Proyecto 2000 endline evaluation, which sampled 5335 mothers living in the catchment areas of 29 treatment and 29 matched control EmOC facilities. Using propensity scoring and two quality of care indices, we find significantly higher quality of care in Proyecto 2000 treatment facilities. Using variance components logistic models, we find a mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Quality of care; Evaluation; Developing countries; Safe motherhood 1. Introduction This study examines two very different efforts to increase institutional delivery in Peru. During 1992–1997, Peru implemented large-scale health sec- tor decentralization reforms. The reforms were criti- cized for widening health disparities, particularly in hospital utilization [1]. Peru’s DHS III (1996) and DHS IV (2000) surveys documented a relative decline in physician-assisted deliveries among rural and poorly ∗ Corresponding author. Tel.: +1 410 502 6037; fax: +1 410 955 2303. E-mail address: mmcquest@jhsph.edu (M.J. McQuestion). educated women over the period. To correct this, the Peruvian Ministry of Health initiated a series of tar- geted maternal and child health interventions, two of which we evaluate. The first intervention was Proyecto 2000, a USAID-funded effort begun in 1996 in the 12 of Peru’s 25 departmentos reporting the highest mater- nal mortality levels. Proyecto 2000 aimed to increase the proportion and quality of institutional deliveries, thereby reducing maternal mortality and improving birth outcomes. The project began with mass media, health education and social mobilization efforts pro- moting delivery in the nearest public emergency obstet- ric care (EmOC) facility. Its emphasis, however, was on improving the quality of services on offer. The sec- 0168-8510/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2005.07.007