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Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria
Last registered on April 02, 2019

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
Last updated
April 02, 2019 11:02 AM EDT
Location(s)

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Primary Investigator
Affiliation
RAND
Other Primary Investigator(s)
Additional Trial Information
Status
On going
Start date
2017-03-01
End date
2020-06-30
Secondary IDs
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. 2019. "Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria." AEA RCT Registry. April 02. https://doi.org/10.1257/rct.1958-2.0.
Former Citation
Okeke, Edward. 2019. "Primary Care Provider Supply and Patient Outcomes: A Cluster Randomized Trial in Nigeria." AEA RCT Registry. April 02. https://www.socialscienceregistry.org/trials/1958/history/44556.
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
Not available
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)
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