Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria

Last registered on October 19, 2022
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Pre-Trial

Trial Information

General Information

Title
Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria
RCT ID
AEARCTR-0001958
Initial registration date
March 06, 2017

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
March 06, 2017, 10:28 AM EST

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

Last updated
October 19, 2022, 10:11 AM EDT

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

Locations

Country
Nigeria
Region
Africa

Primary Investigator

Name
Edward Okeke
Affiliation
RAND
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
Completed
Start date
2017-03-01
End date
2022-06-30
Keywords
Health, Labor
Additional Keywords
health workers, supply, cash transfers
JEL code(s)
I12, J24, O15
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Despite a multitude of programs aimed at improving supply of primary health care providers in underserved communities, there is little convincing micro-evidence about the relationship between primary care provider supply and outcomes. In this study we circumvent thorny identification issues by randomly assigning primary care providers to health facilities and communities. 180 primary health care facilities in Nigeria are participating in this study. Two-thirds of these facilities will be randomly assigned an extra primary care provider (in addition to existing providers) who will practice there for a year. The remaining one-third will maintain the status quo and serve as a control group. We further examine whether the 'quality' of the assigned provider matters for outcomes. A relevant and easily observable proxy of quality is whether or not the provider is a doctor. Within the group of facilities assigned to receive an additional provider, we randomly assign one-half to receive a doctor while the other half receive a mid-level provider similar in skill level to existing providers in the facility. Within this trial, we embed a maternal conditional cash transfer intervention in which pregnant women can receive up to $16 if they attend antenatal and postnatal care, and deliver in the study health facility. Approximately half of participating women are assigned to this cash transfer arm while the other half are assigned to a control arm. We study the effect of the cash transfer on maternal health-seeking behavior and on maternal and newborn outcomes.
External Link(s)

Registration Citation

Citation
Okeke, Edward. 2022. "Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria." AEA RCT Registry. October 19. https://doi.org/10.1257/rct.1958-2.1
Former Citation
Okeke, Edward. 2022. "Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria." AEA RCT Registry. October 19. https://www.socialscienceregistry.org/trials/1958/history/159186
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)

1. Primary Care Provider (PCP) Treatment: Selected primary health care (PHC) facilities will be randomly assigned an additional primary care provider (either a doctor or a mid-level provider)

2. Maternal conditional cash transfer (CCT) Treatment: Selected pregnant women will receive a cash transfer conditional on attending antenatal care, delivering in the health facility, and attending postnatal care
Intervention Start Date
2017-03-01
Intervention End Date
2018-08-30

Primary Outcomes

Primary Outcomes (end points)
Health care utilization, quality of care, physical health score, child weight and height, mortality and morbidity
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
This is a cluster-randomized trial. 120 (out of 180) participating primary health care (PHC) facilities will be randomly assigned an additional primary care provider (60 will receive a doctor and 60 will receive a mid-level provider). The remaining 60 facilities will receive no additional providers and will serve as a control group. Within each facility catchment area, approximately half of the enrolled pregnant women will be randomly assigned to receive a cash transfer conditional on attending antenatal and postnatal care, and delivering in the study facility.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Randomization takes place at the cluster level. Participating primary health care facilities will be assigned to either the doctor arm, the mid-level provider arm, or a control arm with stratification by location. Within facility catchment areas we will randomly sample 10-15 enumeration areas and randomly assign half to either the CCT arm or the control arm.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
Provider intervention: 180 primary health care facilities
CCT intervention: Approximately 1800 Enumeration Areas
Sample size: planned number of observations
2,700 households (15 per catchment area) and approximately 10,000 pregnant women (approximately 60 per catchment area)
Sample size (or number of clusters) by treatment arms
Primary Care Provider: 60 facilities - doctor, 60 facilities - mid-level provider, and 60 facilities - control
Maternal CCT: Approximately 5,000 women - CCT, and 5,000 women - control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
RAND Human Subjects Protection Committee
IRB Approval Date
2015-09-10
IRB Approval Number
FWA00003425
IRB Name
Aminu Kano Teaching Hospital Research Ethics Committee
IRB Approval Date
2016-11-02
IRB Approval Number
AKTH/MAC/SUB/12A/P-3/VI/1923
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
September 30, 2018, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
December 30, 2018, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
180
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
10586 women
Final Sample Size (or Number of Clusters) by Treatment Arms
60 health service areas control, 60 health service areas mid-level provider, 60 health service areas doctor
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials