Generating and then meeting demand: If and how radio can increase demand and supply of health services in Tanzania

Last registered on May 13, 2024

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Pre-Trial

Trial Information

General Information

Title

Generating and then meeting demand: If and how radio can increase demand and supply of health services in Tanzania

RCT ID

AEARCTR-0013564

Initial registration date

May 06, 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, 12:12 PM EDT

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

Locations

Country

Tanzania, United Republic of

Region

Primary Investigator

Name

John Marshall

Affiliation

Columbia University

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Constantine Manda

PI Affiliation

University of California, Irvine; Economic and Social Research Foundation

PI Name

Brenda Nyambo

PI Affiliation

Economic and Social Research Foundation

PI Name

Noela Ringo

PI Affiliation

Economic and Social Research Foundation

PI Name

Zakayo Zakaria

PI Affiliation

Economic and Social Research Foundation

PI Name

Marco Kitundu

PI Affiliation

Economic and Social Research Foundation

PI Name

Dylan Groves

PI Affiliation

Lafayette College

Contact Investigator

PI Name

Andrew Kilale

PI Affiliation

National Institute of Medical Research

Additional Trial Information

Status

On going

Start date

2023-02-01

End date

2024-12-31

Keywords

Governance, Health

Additional Keywords

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Radio programming has the potential to inform citizens of the value of public health services as well as inform and motivate supply-side improvements. Moreover, by generating expectations of receiving high-quality services as well as enabling and incentivizing bureaucrats to meet elevated uptake, these demand- and supply-side forces may be complements. Crossing demand- and supply-side interventions, this field experiment evaluates whether local radio journalists can increase utilization of higher quality health services across non-urban Tanzania. The demand-side intervention leverages an entertaining drama series and locally-tailored content to combat misperceptions about health issues and model service uptake behaviors. The supply-side intervention involves journalists conducting investigations to inform district bureaucrats about facility-level service delivery challenges, before returning to report on improvements (or lack thereof) in service delivery. Partnering with Tanzania’s National Institute of Medical Research, we draw on citizen and bureaucrat surveys, unannounced health facility audits, and administrative data to evaluate the effect of these two interventions, several key subcomponents of each, and their interaction on health service utilization, service quality, and citizen health outcomes. The results will illuminate the extent to which and the mechanisms through which local journalism can increase demand for critical services and hold local government accountable in a developing context with limited electoral pressures and media freedoms.

External Link(s)

Registration Citation

Citation

Groves, Dylan et al. 2024. "Generating and then meeting demand: If and how radio can increase demand and supply of health services in Tanzania." AEA RCT Registry. May 13. https://doi.org/10.1257/rct.13564-1.0

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Experimental Details

Interventions

Intervention(s)

Crossing demand- and supply-side interventions, this field experiment evaluates whether local radio journalists can increase utilization of higher quality health services across non-urban Tanzania. The demand-side intervention leverages an entertaining drama series and locally-tailored content to combat misperceptions about health issues and model service uptake behaviors. The supply-side intervention involves journalists conducting investigations to inform district bureaucrats about facility-level service delivery challenges, before returning to report on improvements (or lack thereof) in service delivery. See pre-analysis plan for more details.

Intervention Start Date

2023-09-11

Intervention End Date

2024-10-31

Primary Outcomes

Primary Outcomes (end points)

COVID-19 vaccination uptake; public health service utilization; quality of public health services; citizen health outcomes. See pre-analysis plan for more details.

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)

See pre-analysis plan.

Secondary Outcomes (explanation)

Experimental Design

This intervention tests the effects of radio-based demand- and supply-side intervention, randomizing the two-series demand-side intervention at the radio station level (further varying local mobilization campaigns at the health facility level) and cross-randomizing the information and information and accountability versions of the supply-side intervention at the health facility level. A complementary individual-level intervention will use listening incentives to assess effects of a more limited version of the demand-side intervention. See pre-analysis plan for more details.

Experimental Design Details

Not available

Randomization Method

Randomization by researcher computer.

Randomization Unit

The demand-side intervention is randomized at radio station and facility catchment area levels; the incentivized demand side intervention is evaluated at the individual level. The supply-side intervention is randomized at the facility catchment area level.

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

48 radio stations, 565 health facility catchment areas (covered by the radio stations).

Sample size: planned number of observations

48 radio stations, 565 health facilities, ~4,600 citizens (8 per facility), 1,925 citizens in the incentivized study.

Sample size (or number of clusters) by treatment arms

24 treated and 24 control radio stations; 139 health facilities receive the demand-side mobilization treatment, the remaining 138 facilities covered by treated radio stations do not; 926 individuals are treated in the incentivized demand-side intervention and 963 are controls; 142 health facilities receive the information-only supply-side treatment, 140 health facilities receive the information and accountability supply-side treatment, and 283 health facilities are supply-side controls.

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Supporting Documents and Materials

IRB