Randomising access to quality care in South Africa

Last registered on May 13, 2024
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Pre-Trial

Trial Information

General Information

Title
Randomising access to quality care in South Africa
RCT ID
AEARCTR-0013554
Initial registration date
May 03, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
May 13, 2024, 11:58 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Mylene Lagarde
Affiliation
LSE
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Other Primary Investigator(s)

PI Name
Nick Stacey
PI Affiliation
PI Name
Duane Blaauw
PI Affiliation

Additional Trial Information

Status
On going
Start date
2024-01-20
End date
2025-02-20
Keywords
Health
Additional Keywords
Quality care; distance; access; healthcare use
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
In South Africa, the health system is characterised by stark inequalities, with most of the population only able to seek care in free government facilities. The low quality of the public sector, where patients wait long times to be seen by nurses, is believed to lead many to delay needed care and prevent health outcome improvement. The government of South Africa is developing proposals to introduce a national health insurance scheme that would provide free access to private providers who deliver higher care quality. However, concerns about the unequal geographical distribution of private providers raise questions about the potential benefits of the reform. This study asks several questions to inform this reform: (1) Does access to higher-quality care reduce under-use of services for children? (2) does it also increase overuse? (3)
Are these effects mitigated by the distance to the contracted providers?
We answer these questions by using an RCT where approx. 1,300 parents/guardians of children under 6 will be randomly allocated to a control group with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close by or relatively far.
External Link(s)

Registration Citation

Citation
Blaauw, Duane, Mylene Lagarde and Nick Stacey. 2024. "Randomising access to quality care in South Africa." AEA RCT Registry. May 13. https://doi.org/10.1257/rct.13554-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
The aim is to provide free access to private providers whose quality is perceived to be higher by local populations. Private providers in Soweto include private doctors who have a practice and small private clinics managed by nurses.
Participants in the intervention arms will be able to take their child to receive free consultations and treatment in a small network of contracted private healthcare providers (both doctor and nurse clinics). Depending on the treatment arms, access will be granted to either network conveniently located in or near their neighborhoods, or further away. The experimental variation of distance is meant to the impact of distance on health-seeking patterns.
Intervention Start Date
2024-02-20
Intervention End Date
2024-05-20

Primary Outcomes

Primary Outcomes (end points)
Underuse: number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian
Overuse: proportion of primary health care visits that are considered unnecessary
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Out-of-pocket expenditures: Direct (consultations, drugs) and indirect (transport) expenditures spent on health care
Illness duration over the period: number of days with ill-health symptoms
Health knowledge: knowledge score of parents in relation to preventive and curative care.
Beliefs about provider quality: expected quality (correct diagnosis, waiting time) about public and private providers
Willingness-to-pay for a consultation with a private provider
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Participants will be randomised to one of three groups:
- Control group: participants will have free access to government facilities (usual care)
- Convenient group: In this group, for the duration of the study, participants will be given free care for their child at any private provider part of a network located relatively close by (less than 30 minutes).
- Inconvenient group: In this group, for the duration of the study, participants will be given free care for their child at any private provider part of a network located relatively (about one hour).
Experimental Design Details
Not available
Randomization Method
Randomisation done in STATA after baseline.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
Approx 1,300 individuals
Sample size: planned number of observations
Approx 1,300 individuals
Sample size (or number of clusters) by treatment arms
Approx. n=435 per arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
University of Witwatersrand
IRB Approval Date
2024-02-15
IRB Approval Number
H22/03/32
IRB Name
LSE
IRB Approval Date
2022-03-17
IRB Approval Number
57203
Analysis Plan