IMPACT EVALUATION OF COMMUNITY RESULTS BASED FINANCING ON EARLY INITIATION OF ANTENATAL VISIT AMONG PREGNANT WOMEN: A MATCHED PAIR, PARALLEL DESIGN CLUSTER RANDOMISED TRIAL
Last registered on December 09, 2019

Pre-Trial

Trial Information
General Information
Title
IMPACT EVALUATION OF COMMUNITY RESULTS BASED FINANCING ON EARLY INITIATION OF ANTENATAL VISIT AMONG PREGNANT WOMEN: A MATCHED PAIR, PARALLEL DESIGN CLUSTER RANDOMISED TRIAL
RCT ID
AEARCTR-0004715
Initial registration date
December 06, 2019
Last updated
December 09, 2019 2:21 PM EST
Location(s)

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Primary Investigator
Affiliation
University of Zambia
Other Primary Investigator(s)
PI Affiliation
Ministry of Health
PI Affiliation
Ministry of Health
PI Affiliation
Ministry of Health
PI Affiliation
Ministry of Health
PI Affiliation
Ministry of Health
PI Affiliation
University of Zambia
PI Affiliation
University of Zambia
PI Affiliation
University of Zambia
PI Affiliation
Center of Distributive, Labor and Social Studies
Additional Trial Information
Status
In development
Start date
2020-01-01
End date
2020-06-30
Secondary IDs
PIERI 20379
Abstract
Results Based Financing (RBF) has been heralded as an effective tool for motivating health workers to improve maternal and child health indicators. However, focus has been on frontline health workers and little attention has been given to Community Health workers (CHWs). Yet CHWs have been found to be an effective cadre in improving maternal, newborn, and child health indicators, including ANC and facility deliveries. The study proposes to evaluate the effect of the community RBF on initiation of antenatal care in the first trimester. To achieve this, we will employ a cluster-randomized trial with pairwise matching where 49 health facilities are randomly allocated to the treatment arm and 49 to the control arm in Central province in Zambia. The study is targeted at Central province due to the relatively poor performance in the province. In each of the health facilities, 6 neighborhood health committees will be informed that for each woman they bring for ANC within the first trimester, they will be paid a fee. To ensure balance between the intervention and control, we will use administrative data on health facility characteristics such as distance to the district medical office, number of maternity beds and population catchment area to implement a covariate constrained pairwise matching procedure. We also examine whether incentivising first antenatal attendance translates to increased facility deliveries and whether other non-incentivized indicators such as post-natal attendance in the first six days post-delivery increase in line with an increase in the timing of first ANC visit.
External Link(s)
Registration Citation
Citation
Alzua , Maria Laura et al. 2019. "IMPACT EVALUATION OF COMMUNITY RESULTS BASED FINANCING ON EARLY INITIATION OF ANTENATAL VISIT AMONG PREGNANT WOMEN: A MATCHED PAIR, PARALLEL DESIGN CLUSTER RANDOMISED TRIAL." AEA RCT Registry. December 09. https://doi.org/10.1257/rct.4715-1.0.
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Experimental Details
Interventions
Intervention(s)
In each of the health facilities, 6 neighborhood health committees will be informed that for each woman they bring for ANC within the first trimester, they will be paid a fee.
Intervention Start Date
2020-01-01
Intervention End Date
2020-06-30
Primary Outcomes
Primary Outcomes (end points)
Proportion of pregnant women attending antenatal care clinic in their first trimester.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
• Number of referred pregnant women for first ANC visit by the Safe Motherhood Action Groups
• Proportion of pregnant woman giving birth at a health facility
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We will employ a cluster-randomized trial with pairwise matching between groups where 49 health facilities are randomly allocated to treatment and 49 others to control in Central province in Zambia
Experimental Design Details
Not available
Randomization Method
Pairwise matching was undertaken on the 98 rural health facilities, using facility level characteristics: number of maternity beds, distance from the district medical office and the population catchment area, yielding 49 pairs. These 49 pairs were randomly allocated to treatment and control sites by the researchers (49 in the treatment arm an 49 in the control arm).
Randomization Unit
health facility
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
49 facilities per arm
Sample size: planned number of observations
98 facilities
Sample size (or number of clusters) by treatment arms
49 facilities per arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We use the following characteristics to determine the power of the study: 1) Proportion of pregnant women attending ANC in the first trimester is estimated at 24% according to the 2018 Zambia Demographic Health Survey 2) We assume a minimum detectable effect of 15% points (Based on a study involving community health workers and maternal health outcomes) 3) Type one error probability is set at 5%. 4) Intra-cluster correlation of 0.06 (Based on a prior study in Zambia) 5) Sample size of 49 health facilities in treatment and the same number in control determined using pairwise matching. 6) Average of 6 NHCs per facility. The power of the study, based on these characteristics is 93.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
ERES CONVERGE IRB
IRB Approval Date
2019-11-29
IRB Approval Number
IRB No. 00005948