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Impact of family planning and business trainings on private sector health providers: Results from an RCT in Nigeria
Last registered on November 25, 2016

Pre-Trial

Trial Information
General Information
Title
Impact of family planning and business trainings on private sector health providers: Results from an RCT in Nigeria
RCT ID
AEARCTR-0001803
Initial registration date
November 25, 2016
Last updated
November 25, 2016 10:53 AM EST
Location(s)
Region
Primary Investigator
Affiliation
Tufts University
Other Primary Investigator(s)
PI Affiliation
Strengthening Health Outcomes through the Private Sector (SHOPS), USAID
PI Affiliation
Strengthening Health Outcomes through the Private Sector (SHOPS), USAID
PI Affiliation
Global Development Lab at USAID
PI Affiliation
Abt Associates
PI Affiliation
Abt Associates
PI Affiliation
Abt Associates
Additional Trial Information
Status
Completed
Start date
2013-01-01
End date
2014-09-30
Secondary IDs
Abstract
Through a randomized experiment, this study measures the impact of an innovative multi-faceted package of trainings-related activities targeted to private health providers in Nigeria on healthcare and financial outcomes. Facilities in the treatment group were offered a comprehensive training package that included counseling skills, contraceptive technology update, clinical skills, and business practices, while facilities in control were offered no training. Using data collected through facility and mystery client surveys, we estimated impacts on multiple healthcare and financial outcomes. Treated facilities increased the range of contraceptive methods offered by 10.2 percent relative to control facilities. Assignment to treatment also increased the overall quality of a provider's counseling services, interpersonal skills, and overall knowledge. Business practices also improved, although there was no effect on revenue generation.
External Link(s)
Registration Citation
Citation
Baruwa, Sikiru et al. 2016. "Impact of family planning and business trainings on private sector health providers: Results from an RCT in Nigeria." AEA RCT Registry. November 25. https://doi.org/10.1257/rct.1803-1.0.
Former Citation
Baruwa, Sikiru et al. 2016. "Impact of family planning and business trainings on private sector health providers: Results from an RCT in Nigeria." AEA RCT Registry. November 25. http://www.socialscienceregistry.org/trials/1803/history/12009.
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Experimental Details
Interventions
Intervention(s)
To address the gap in private health providers' family planning knowledge, healthcare skills, and business practices, the research team designed an intervention including different types of trainings, supportive supervision services, and other complementary services aimed at doctors, nurses, and/or nurse midwives.

1) Trainings Treatment: Private health providers were offered a comprehensive training package that included sessions on counseling skills, contraceptive technology update, clinical skills, and business practices. The providers then decided which training sessions, if any, their staff would participate in. Supportive supervision services, and other complementary services were also offered.
2) Control: Private health providers were not offered any elements of the training package or complimentary services.

Since each private health provider independently chose which training sessions and complimentary services to take advantage of, our analysis employs an “intent-to-treat” approach to examine the impact of offering the multi-faceted intervention, regardless of participation in the training sessions.
Intervention Start Date
2013-01-01
Intervention End Date
2013-04-30
Primary Outcomes
Primary Outcomes (end points)
Healthcare: the range of contraceptive methods offered, overall quality of counseling services, provider interpersonal skills, provider overall knowledge.
Business Practices: record-keeping, loan applications, current loans, revenue generation.
Primary Outcomes (explanation)
Overall quality of counseling services: This includes the ability to gauge patient preferences regarding family planning, rule out pregnancy, and check for contraindications the range of contraceptive methods discussed by the providers.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
This study used a randomized controlled trial research design, with a baseline survey (prior to randomization) and an endline survey of the 965 private healthcare facilities. We randomly assigned those 965 private health facilities into either a treatment group (484 facilities) or a control group (481 facilities) using the following steps for stratification: First, we created strata for each of the 20 local government areas, or LGA, creating 20 “primary cells.” We made sure that each cell contained at least four facilities in order to avoid sparsely populated cells. Second, we created sub-strata. This was done as follows. For primary cells with more than 16 facilities, we created sub-strata by splitting the primary strata into those above and below the median vignette score (defined below) and, within each of the resulting sub-strata, splitting again into those above and below the median business score . Thus, we created “final cells,” which were groupings of facilities from the same LGA and, if the sample size permitted, were also similar in terms of the vignette score and business score. Finally, we randomly assigned all 965 facilities, one by one within each of those ‘final cells’ to either a control or treatment group.
Experimental Design Details
Randomization Method
After stratification (explained in the "Experimental Design" section), we randomly assigned all 965 facilities, one by one within each of those ‘final cells’ to either a control or treatment group.
Randomization Unit
private healthcare facility
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
No clusters.
Sample size: planned number of observations
965 private healthcare facilities
Sample size (or number of clusters) by treatment arms
484 private healthcare facilities treatment, 481 private healthcare facilities control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We carried out power calculations to determine minimum detectable effect on several key outcomes: an increase of 9 percentage points in the average quality of family planning counseling session, and an increase of 10 percentage points in the likelihood of a facility applying for and obtaining a loan, which required a total of 800 and 600 facilities, respectively. For these power calculations, we set alpha (the probability of type I error) to .05 and power to .8, and estimated that 75 percent of facilities in the treatment group would attend at least one of the training sessions (it ended up being 85 percent, slightly improving our power relative to our calculations).
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Northwestern University Institutional Review Board
IRB Approval Date
2012-09-24
IRB Approval Number
STU00067233
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
April 30, 2014, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
September 30, 2014, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
No clusters.
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
832 private healthcare facilities
Final Sample Size (or Number of Clusters) by Treatment Arms
418 private healthcare facilities treatment, 414 private healthcare facilities control.
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS