Healthcare Delivery in Sierra Leone

Last registered on March 10, 2017

Pre-Trial

Trial Information

General Information

Title
Healthcare Delivery in Sierra Leone
RCT ID
AEARCTR-0002085
Initial registration date
March 09, 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 10, 2017, 10:14 AM EST

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

Locations

Region

Primary Investigator

Affiliation
Stockholm University

Other Primary Investigator(s)

PI Affiliation
The World Bank
PI Affiliation
University of Chicago

Additional Trial Information

Status
Completed
Start date
2011-09-01
End date
2013-07-01
Secondary IDs
Abstract
Over the past decade, the Government of Sierra Leone (GoSL) has made a concerted effort to improve health care services throughout the country, including an ambitious free health care initiative launched in 2010. Key to the success of the initiative was strengthening the weak incentives faced by front-line health providers—for example, in early 2010, a large share of health staff were compensated entirely through informal fee payments from users and margins from drug sales. To alleviate basic resource constraints, the GoSL increased worker salaries and the flow of resources to clinics nationwide, and sought to introduce non-financial incentive schemes, which recent studies have shown to be highly effective in improving worker performance in a range of environments. However, could such schemes be applied to Sierra Leone’s health sector, and if so, what types of non-financial incentives would work best?

To answer this question, the GoSL, in conjunction with the World Bank, the Center for the Study of African Economies, and Innovations for Poverty Action, launched a randomized controlled trial to test the effectiveness of two innovative interventions using non-financial incentives to improve health care outcomes. The first intervention involved community monitoring of health clinics through the use of health scorecards and collaborative meetings between community members and health staff. The second intervention used non-financial awards, such as public commendations, with the aim of improving worker motivation and promoting greater efficiency within health clinics. This document is an analysis plan for gauging the effects of these interventions, and builds on an initial report released by Innovations for Poverty Action in 2014.
External Link(s)

Registration Citation

Citation
, , Johannes Haushofer and Bilal Siddiqi. 2017. "Healthcare Delivery in Sierra Leone." AEA RCT Registry. March 10. https://doi.org/10.1257/rct.2085
Former Citation
, , Johannes Haushofer and Bilal Siddiqi. 2017. "Healthcare Delivery in Sierra Leone." AEA RCT Registry. March 10. https://www.socialscienceregistry.org/trials/2085/history/14852
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2011-09-01
Intervention End Date
2013-07-01

Primary Outcomes

Primary Outcomes (end points)
Maternal healthcare utilization, health service delivery, health clinic quality, health outcomes, general utilization, community health engagement, health satisfaction, community water and sanitation, collective action, economic status.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Clinics and their catchment area were randomly selected to participate in one of the interventions (they constitute the “treatment group”) or to act as control. Within each clinic catchment, two communities were randomly selected, and households were randomly sampled from within these communities. This methodology ensures that observed and unobserved characteristics likely to affect health outcomes and clinics effectiveness are similarly distributed across treatment and control groups before the intervention. Consequently, any difference in indicators of interest between treatment and control groups observed after the intervention can be interpreted as the effect of the intervention itself.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Randomization took place at the clinic level.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
254 clinics.
Sample size: planned number of observations
5,080 households.
Sample size (or number of clusters) by treatment arms
~85 clinics in each treatment arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information
IRB

Institutional Review Boards (IRBs)

IRB Name
Study has received IRB approval. Details not available.
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Analysis Plan

Analysis Plan Documents

Healthcare Delivery in Sierra Leone

MD5: 2e56a7f9d07e7767ab4e70f3d88109b7

SHA1: 675d55dd4605f60247782140e3b140b93acd2507

Uploaded At: March 09, 2017

Post-Trial

Post Trial Information

Study Withdrawal

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information

Intervention

Is the intervention completed?
No
Data Collection Complete
Yes
Data Collection Completion Date
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials