Improving Full Immunization Rates in Haryana: Evaluating Incentives and Communication Methods

Last registered on September 25, 2018

Pre-Trial

Trial Information

General Information

Title
Improving Full Immunization Rates in Haryana: Evaluating Incentives and Communication Methods
RCT ID
AEARCTR-0001434
Initial registration date
October 06, 2016
Last updated
September 25, 2018, 2:22 AM EDT

Locations

Region

Primary Investigator

Affiliation
MIT

Other Primary Investigator(s)

PI Affiliation
PI Affiliation
World Bank
PI Affiliation
J-PAL Global, MIT
PI Affiliation
Stanford University
PI Affiliation
MIT
PI Affiliation
Stanford University
PI Affiliation
J-PAL South Asia at IFMR
PI Affiliation
J-PAL Global, MIT

Additional Trial Information

Status
On going
Start date
2014-11-01
End date
2019-03-31
Secondary IDs
Abstract
The primary purpose of this program is to increase the coverage of full immunization rates among children under 12 months of age in seven poor-performing districts of the state of Haryana, India. This will be done by providing non-cash incentives to parents to motivate them to consistently immunize their children. Previous research conducted in Rajasthan, India shows that lack of demand for immunization may be a key reason for low rates of full immunization, even when supply-side bottlenecks have been removed. Thus, this study will rigorously evaluate the effectiveness of providing incentives to beneficiaries in increasing full first-year routine immunization rates in Haryana. It will also look at the scalability of this approach in improving immunization coverage under the current government framework. Along with the immunization incentives experiment, the study conducts two additional experiments to evaluate various communication strategies the government could use to boost immunization rates. The first of these analyzes the potential role of village social networks: community members are asked to nominate individuals from their village who they consider good at spreading information, trustworthy in the village, or a combination of the two. These nominated 'seeds' will be expected to spread the information that they receive about immunization to other members in their community. This experiment evaluates different approaches that policymakers could use to mobilize well-suited community members to increase immunization rates. The second one, targeted reminders experiment, will provide reminders via text messages to primary caregivers, customized to the vaccination schedule of their children. This experiment is designed to evaluate a low-cost and scalable targeted immunization information system. Both of these experiments will be cross-randomized with the larger incentive experiment, which will shed more light on the efficacy of the interactions of these experiments with the incentive program.
External Link(s)

Registration Citation

Citation
Banerjee, Abhijit et al. 2018. "Improving Full Immunization Rates in Haryana: Evaluating Incentives and Communication Methods." AEA RCT Registry. September 25. https://doi.org/10.1257/rct.1434-4.0
Former Citation
Banerjee, Abhijit et al. 2018. "Improving Full Immunization Rates in Haryana: Evaluating Incentives and Communication Methods." AEA RCT Registry. September 25. https://www.socialscienceregistry.org/trials/1434/history/34792
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2016-12-19
Intervention End Date
2018-03-31

Primary Outcomes

Primary Outcomes (end points)
a. Full first year immunization rate among children 1-3 years of age. Full first year immunization refers to whether a child has received all five vaccines of the first year immunization schedule viz. BCG, DPT/Penta - I, II, III, and Measles.
b. Flow at immunization session sites. This is measured by the volume of children in the session sites. This data will be collected by the Auxiliary Nurses (ANMs) conducting the vaccination sessions using a data entry application designed specifically for this project.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The program comprises three experiments:
1. Incentives Experiment: This experiment tries to evaluate the impact of incentives to generate demand for child immunization. 140 Primary Health Centers (PHCs), each of which provides health services to about 40 villages, selected from our 7 sample districts were randomly divided in two groups- incentive treatment (group that receives incentives) and incentive control (group that receives no incentives). Incentives will be in the form of mobile credits. Within the incentive group, we further randomize sub-centers (SC), of which there are approximately 5 per PHC, into various levels and slopes of the incentive amount tied with each vaccine:
a. low incentive, flat payment for each vaccine
b. high incentive, flat payment for each vaccine
c. low incentive, increasing payment (incentive amount increases after the third vaccine)
d. high incentive, increasing payment (incentive amount increases after the third vaccine)

2. Communication Experiment: This experiment, which is cross-randomized with the incentive experiment, will study the effectiveness of using various 'seeds' to diffuse information about vaccination as well as convince individuals to immunize their children. For this experiment, 943 villages will be divided into five groups: control group, random seeds group, gossip seeds group, trust seeds group, and trusted gossip seeds group. Each village will have 6 seeds, each of which are identified by seeking nominations from villagers.

3. Targeted Reminders Experiment: The targeted reminders experiment will be conducted across the program districts. Half of the villages will be randomly selected to receive text messages that are tailored to the immunization schedule of the eligible child based on their date of birth collected during the immunization session. The text message will remind primary caregivers about the specific vaccine that the child is due for and when and where it can be administered. This experiment will also be cross-randomized with the incentives experiment.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
1. Incentives experiment: level of randomization is Primary Health Centre (PHC). The variation of incentives is randomized at the Sub-centre level.

2. Communication Experiment: Level of randomization is the village

3. Targeted Reminders Experiment: Level of randomization is the village
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
1. Incentives Experiment: 140 PHCs, 755 SCs
2. Communication Experiment: 943 villages
3. Targeted Reminders Experiment: 2319 villages
Sample size: planned number of observations
Incentives Experiment: 14500 households from the survey Also plan to use administrative data from the application used by the ANMs during immunization session. The application is designed specifically for this project and will collect data on all the shots provided during the program period.
Sample size (or number of clusters) by treatment arms
Incentives Experiment: 70 PHCs -control, 70 PHCs -treatment. Within these 70 treatment PHCs:120 SCs- high incentive, increasing payment, 120 SCs- low incentive, increasing payment, 73 SCs- high incentive, flat payment, 73 SCs- low incentive, flat payment
Communication Experiment: 392 villages- pure control, 130 villages- random seed treatment, 134 villages- gossip seed treatment, 148 villages- trusted seed treatment, 139 villages- trusted gossip treatment
Targeted Reminders Experiment: 1160 villages- control, 1159 villages- treatment
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Committee on the Use of Humans as Experimental Subjects, Massachusetts Institute of Technology
IRB Approval Date
2016-05-19
IRB Approval Number
1511312321
Analysis Plan

Analysis Plan Documents

Pre Analysis Plan

MD5: d9e0e46f66980388b0170b353349e90e

SHA1: 66a740f3a21e081a106bea42d3d4096513f75d53

Uploaded At: July 09, 2018

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials