DISCRETIONARY CASH GRANTS TO HEALTH FACILITIES AND SERVICE DELIVERY

Last registered on November 02, 2023
View Trial History

Pre-Trial

Trial Information

General Information

Title
DISCRETIONARY CASH GRANTS TO HEALTH FACILITIES AND SERVICE DELIVERY
RCT ID
AEARCTR-0004456
Initial registration date
August 28, 2019

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
August 29, 2019, 8:37 AM EDT

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

Last updated
November 02, 2023, 11:19 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
On going
Start date
2019-05-15
End date
2024-04-30
Keywords
Health, Labor
Additional Keywords
cash grants, health facilities, health worker effort, monitoring, service delivery, motivation
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Poor service delivery in the health sector in developing countries is well documented. Health worker effort is increasingly recognized as key to improving these outcomes. This cluster RCT studies the effect of surprise cash awards given to primary health clinics in Nigeria. A key element of the award is that health workers have discretion over how it is to be allocated and spent. The only condition is that the award can only go towards service delivery improvement. Earlier work has shown that giving even small unconditional gifts to health workers can strengthen intrinsic motivation. We hypothesize that the award will lead to greater output of effort by health workers in intervention clinics. In addition, we hypothesize that the award will ease budget constraints and lead to greater investment in complementary inputs. We study the effect of this intervention on service delivery and health outcomes.
External Link(s)

Registration Citation

Citation
Okeke, Edward. 2023. "DISCRETIONARY CASH GRANTS TO HEALTH FACILITIES AND SERVICE DELIVERY." AEA RCT Registry. November 02. https://doi.org/10.1257/rct.4456-1.2
Sponsors & Partners

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

Request Information
Experimental Details

Interventions

Intervention(s)
The primary intervention is a discretionary cash award given to primary health care facilities. Selected primary health care facilities will receive an award of approximately $1,700 (paid out in regular installments over 12 months). The purpose of the award is to support service delivery improvement efforts with emphasis on maternal and child health.
Intervention (Hidden)
The primary intervention is a surprise discretionary cash award given to primary health care facilities. Selected primary health care facilities will receive an award of approximately $1,700 (paid out in regular installments over 12 months). The purpose of the award is to support service delivery improvement efforts with emphasis on maternal and child health. Given that health clinics may lack baseline information about performance on various outcomes, which may lead to inefficient allocation, we, as part of the intervention, provide health workers with information about outcomes in their service areas at baseline.

The award will be announced during rollout visits to the participating health facilities. The visits will be scheduled ahead of time to allow all health workers to be present (community representatives will also be invited). During the visit health workers will receive information about maternal and child health outcomes more broadly, and specific information on (some) outcomes in their service areas (collected during a preliminary survey). The health workers will then be asked to think about why outcomes are poor and ways in which they can be improved. At the end of the visit, they will be encouraged to develop a plan for improving these outcomes. In clinics selected to receive the award, the award will be announced as a gift to support them in their efforts.
Intervention Start Date
2019-05-15
Intervention End Date
2020-12-30

Primary Outcomes

Primary Outcomes (end points)
The primary outcomes are health worker effort, availability and quality of services, and utilization of maternal and child health services
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
The secondary outcomes include process measures and birth outcomes. Specific birth outcomes of interest include stillbirths and infant deaths. We will also examine changes in client perceptions.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
This is a cluster randomized trial. 288 primary health facilities in Nigeria will be randomly assigned to one of three study arms: 96 clinics will receive the cash award + information about baseline performance + encouragement to improve outcomes; one-third will receive information about baseline performance + encouragement to improve outcomes but no additional cash; and the remaining third will serve as a control group.
Experimental Design Details
Randomization Method
Randomization will be carried out by study investigators in office
Randomization Unit
The unit of randomization is the primary health facility
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
288 primary health facilities will participate in the trial
Sample size: planned number of observations
288 health facilities, 2000 health workers, 34,000 births
Sample size (or number of clusters) by treatment arms
96 health facilities per arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
The RAND Corporation
IRB Approval Date
2017-04-06
IRB Approval Number
2017-0219-CR01
Analysis Plan

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
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials