Evaluation of the Step-Up Program in Nigeria and DRC

Last registered on June 17, 2026

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Pre-Trial

Trial Information

General Information

Title

Evaluation of the Step-Up Program in Nigeria and DRC

RCT ID

AEARCTR-0018907

Initial registration date

June 10, 2026

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

June 17, 2026, 8:53 AM EDT

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

Last updated

June 17, 2026, 9:04 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

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Primary Investigator

Name

Philip Anglewicz

Affiliation

Johns Hopkins University

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Other Primary Investigator(s)

PI Name

Carolina Cardona

PI Affiliation

Johns Hopkins University

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PI Name

Celia Karp

PI Affiliation

Johns Hopkins University

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PI Name

Saifuddin Ahmed

PI Affiliation

Johns Hopkins University

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PI Name

Pierre Akilimali

PI Affiliation

University of Kinshasa

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PI Name

Elizabeth Omoluabi

PI Affiliation

CRERD

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PI Name

Mahesh Karra

PI Affiliation

Columbia University

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PI Name

Catalina Herrera

PI Affiliation

University of Illinois Urbana Champagne

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Additional Trial Information

Status

On going

Start date

2024-07-01

End date

2027-06-30

Keywords

Behavior, Health

Additional Keywords

Family planning programs

JEL code(s)

Secondary IDs

Prior work

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

Abstract

A team led by Johns Hopkins Bloomberg School of Public Health (JHU) won a competitive bidding process to lead an evaluation of Marie Stopes International's (MSI) Step-Up Program in Nigeria and the Democratic Republic of the Congo (DRC). Step-Up aims to accelerate the demographic dividend in West Africa and embed nationally owned, gender-transformative models to achieve expanded, locally driven, equitable, efficient, sustainable and & gender- transformative SRHR sector. Through this investment, there is an opportunity to have a substantial impact on family planning and reproductive health outcomes most immediately, and broader health and development goals as well. The team also includes experts in evaluation from Columbia University and the University of Illinois, Urbana-Champaign; and includes the Centre for Research, Evaluation Resources and Development (CRERD), a Nigeria-based organization that has expertise in research and data collection; and Kinshasa School of Public Health (KSPH) in DRC. The three-year evaluation was initiated in July 2024 and will continue until approximately June of 2027. Within Nigeria, the evaluation takes place in Niger and Kogi States, and Haut-Katanga Province in DRC. In Nigeria, the evaluation focuses on two MSI’s programs: (1) Public Sector Strengthening (PSS), and (2) Outreach efforts; in DRC, MSI only implements the Outreach program. The team will implement a cluster- level randomized controlled trial (RCT) with baseline and endline data collection, as well as interim monitoring MSI activities via text-message surveys and analysis of Health Management Information System (HMIS) data.

External Link(s)

Registration Citation

Citation

Anglewicz, Philip et al. 2026. "Evaluation of the Step-Up Program in Nigeria and DRC." AEA RCT Registry. June 17. https://doi.org/10.1257/rct.18907-1.1

Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)

Within Nigeria, the intervention takes place in Niger and Kogi States, and Haut-Katanga Province in DRC. In Nigeria, MSI implements two programs: (1) Public Sector Strengthening (PSS), and (2) Outreach efforts; in DRC, MSI only implements the Outreach program. Outreach aims to provide family planning/reproductive health services to populations that don't have easy access to these services. PSS aims to work with health facilities to improve various aspects of their services, like service quality, reporting systems, etc...

Intervention Start Date

2025-12-01

Intervention End Date

2026-09-30

Primary Outcomes

Primary Outcomes (end points)

The main outcome is modern contraceptive use.

Primary Outcomes (explanation)

The main outcome was selected because MSI's efforts are primarily targeted to affect contraceptive use.

Secondary Outcomes

Secondary Outcomes (end points)

Safe abortion

Secondary Outcomes (explanation)

In addition to contraceptive use, MSI also works to improve safe abortion as part of their Step Up campaign

Experimental Design

This is a cluster-level randomized controlled trial (RCT), in which we identify eligible clusters for the interventions and then randomly assign to control and treatment groups. We will implement a baseline survey that will inform the randomization efforts, then monitory MSI's activities during the intervention period, and finally an endline survey to assess the difference between control and treatment groups, i.e., the impact of MSI's programs.

Experimental Design Details

Not available

Randomization Method

Randomization will be conducted to (1) ensure maximum distance across clusters, (2) use baseline data to ensure that groups of cluster in control and treatment groups are similar in all characteristics before the intervention begins. This is done through assessment using Stata and R.

Randomization Unit

The randomization units are clusters of approximately 200 households, that lie within the eligible areas in Nigeria and DRC.

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

Based on power calculations, in Haut-Katanga, we need 94 clusters for outreach. In Niger and Kogi, we need 105 clusters in each.

Sample size: planned number of observations

We expect to interview at least 3290 respondents (women aged 15-49) in Haut Katanga, and 3,675 respondents in Niger and Kogi States apiece.

Sample size (or number of clusters) by treatment arms

In Nigeria, based on sample size calculations, we need a total of 82 clusters (41 per state) for the outreach program, and 128 clusters (64 per state) for the PSS program in Nigeria. For the Outreach program in Haut-Katanga (DRC), we required 94 clusters, evenly split between treatment and control (47 each).

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

Prior literature has evidenced that the use of contraception increases at a faster pace in populations where there is low usage of contraception compared to high usage populations. The rates we implemented were: i) a relative increase of 2 times for modern use < 5%, ii) a relative increase of 1.75 for 5% ≤ modern use < 10%, iii) a relative increase of 1.6 for 10% ≤ modern use < 15%, iii) a relative increase of 1. 5 for 15% ≤ modern use < 20%, iv) a relative increase of 1.4 for 20 ≤ modern use <25%, and v) a relative increase of 1.35 for modern use 25% ≤ modern use <30%. We did not consider a fixed absolute value of the effect-size (expected relative increase in modern use) because the pace of change may be different due to differences in the baseline levels across the sites/regions. Statistical power was set at 80% for the Outreach trials. For the PSS trials in Niger and Kogi, maintaining a pure (untreated) control group was not feasible, because other public-sector health programs, whose details were not known in advance and which can influence the delivery of FP services (referred to as “incentives”), operate in these states. To retain adequate power for detecting effects across subgroups of women (heterogeneity analyses) and for secondary fertility-related outcomes such as pregnancy, and as insurance against attenuation from these co-occurring programs, power for the PSS trials was set at 95%.

Supporting Documents and Materials

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