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The effect of community mobilization on healthcare quality. Evaluating the Remote Assistance and Coaching Helpline (REACH) in Cote d’Ivoire
Last registered on April 30, 2019

Pre-Trial

Trial Information
General Information
Title
The effect of community mobilization on healthcare quality. Evaluating the Remote Assistance and Coaching Helpline (REACH) in Cote d’Ivoire
RCT ID
AEARCTR-0004132
Initial registration date
April 30, 2019
Last updated
April 30, 2019 9:40 AM EDT
Location(s)

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Primary Investigator
Affiliation
Stanford university
Other Primary Investigator(s)
Additional Trial Information
Status
On going
Start date
2018-01-05
End date
2020-12-31
Secondary IDs
Abstract
Many initiatives aim to improve the quality of public services in low-income countries by fostering better governance through citizens’ participation. The underlying theory of change is that end-users have the most at stakes in seeing the availability and quality of services improve. Few of these initiatives have been rigorously evaluated, and the evidence is mixed. In healthcare, all successful initiatives have included both a substantial dose of training and an expensive, in-person support system from project implementers. This is typically not scalable. Our project aims to test an affordable hence scalable and sustainable mechanism to empower citizens to get involved and improve the quality of public healthcare. We are targeting rural Cote d’Ivoire, where past interventions have failed. In collaboration with the healthcare administration, we are working with CARE Cote d’Ivoire to set-up inclusive management committees that receive assistance and coaching by a Health Management expert via telephone.
External Link(s)
Registration Citation
Citation
APEDO-AMAH, Dedevi. 2019. "The effect of community mobilization on healthcare quality. Evaluating the Remote Assistance and Coaching Helpline (REACH) in Cote d’Ivoire." AEA RCT Registry. April 30. https://doi.org/10.1257/rct.4132-1.0.
Former Citation
APEDO-AMAH, Dedevi. 2019. "The effect of community mobilization on healthcare quality. Evaluating the Remote Assistance and Coaching Helpline (REACH) in Cote d’Ivoire." AEA RCT Registry. April 30. https://www.socialscienceregistry.org/trials/4132/history/45730.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The Remote Assistance & Coaching Helpline (REACH) program consists of three steps as follows:
Step 1: Village meeting to inform the population on management committees’ role and form the committees (COGES) with volunteers. The facilitator encourages diversity and inclusivity: women, youths, all ethnic groups, and all villages surrounding the medical area should be represented. To conform to the healthcare administration’s requirement, the target number of members is 15-20 per COGES.
Step 2: Training and matching with a coach. COGES members are invited to a two-day training session, which takes place shortly after the village meeting at a centralized location (six COGES can be trained at a time). They are trained in their specific roles and structure their association. Trained COGES are then matched to a trained “Reacher”. The Reacher is a full-time worker hired as "coach" through CARE, the NGO partner. Reachers are hired for their knowledge in community initiatives monitoring, business, and fundraising. A Reacher is matched (in charge of) 20 trained COGES. Reachers work out of a call-center inside CARE’s office and under the direct supervision of the project manager.
Step 3: Remote Assistance & Coaching. For 12 months after the training, Reachers monitor COGES’ activities through bi-monthly phone meetings with COGES members. They also encourage and support the COGES in reporting to or contacting the healthcare district for matters that require their intervention, and bring COGES members in touch with other COGES in the same district whose experience may be relevant/helpful. Outside of the scheduled phone meetings, the help phone line is opened from 9am-5pm, 5 days a week for when a COGES needs urgent assistance.


Intervention Start Date
2019-06-01
Intervention End Date
2020-06-30
Primary Outcomes
Primary Outcomes (end points)
- Quality of care (using quality indexes of the Performance-based financing scheme run by the CI Ministry of Health)
- Management committee activities
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
- Money inflows to the facility: performance based financing inflows, donations.
- Use of the healthcare facility
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The facility is our unit of randomization. We stratify by health districts and number of visits. Our sample is composed of 90 health care facilities with their catchment area. We randomize in three groups:
Treatment 1 : 30 facilities that go through all the three stages of the intervention as described above.
Treatment 2 : 30 facilities that go through all the three stages of the intervention. In addition, at the end of the training we give a strong nudge that at least 50% of the leadership position should be held by women.
Control : 30 facilities that go through only stage one of the intervention (village meeting).
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer using Stata.
Randomization Unit
The healthcare facility is our unit of randomization. Healthcare facilities in treatment groups are randomly assigned to a Reacher. Each reacher is in charge of 20 COGES.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
90 rural healthcare facilities.
Sample size: planned number of observations
1800 households, 90 COGES.
Sample size (or number of clusters) by treatment arms
30 REACH only, 30 REACH + gender, 30 Control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Stanford University IRB
IRB Approval Date
2019-03-01
IRB Approval Number
IRB (FWA00000935), protocol number 48655