Our sample consists of 72 health facilities selected for inclusion based on a census conducted of all of the public and private health facilities (over 300) in one region of Ghana, which for confidentiality purposes shall remain unnamed.
Inclusion criteria for health centers in the study were: (1) having an antenatal care clinic (ANC); (2) being rural; (3) having no other healthcare facilities within a 2 km radius, no hospitals within a 5 km radius, and not more than one other ANC within a 5 km radius (this was to keep subsidy costs manageable by limiting the potential increase in ANC attendance in response to the program); (4) having no free LLIN program currently in place (very few had); (5) having at least two stores within a 2 km radius willing to participate in a voucher scheme whereby health centers distribute vouchers redeemable at the store (only 6% of clinics were excluded by this criterion); and, (6) being accessible for net deliveries (less than 2% were inaccessible).
We asked selected health facilities to participate in a bed net distribution program called "SALI" and sponsored by the NGO JPAL. The bednet distribution program targeted pregnant seeking prenatal care. Each prenatal care registrant was eligible to one free long-lasting insecticide treated net.
We randomized the following features of the distribution program:
1. Distribution mechanism: whether the subsidized product was distributed directly through health facilities, or indirectly through a voucher scheme wherein the clinic distributes vouchers that could be redeemed at local stores (Direct vs. Voucher). We also randomized whether vouchers could be redeemed in 1 or 2 stores (1-store vs. 2-store)
2. Staff monitoring: whether the health works were told the distribution program would be monitored through audits (Audit threat vs. No Audit threat)
3. Incentives: whether, for Direct Distribution clinics only, the health worker received compensation for implementing the distribution (Compensation vs. No Compensation)
4. Stock levels: whether, for Direct clinics only, the clinic receives a high or low level of net stock (High stock vs. Low stock)