Experimental Design
The experimental design is a matched-pair, longitudinal cluster randomised controlled trial (RCT), with randomization at the village level. We first randomly selected 24 villages in the catchment area of four health facilities (six per health facility). We then matched villages in 12 pairs using Euclidean distance measures, based on village-level characteristics and aggregated household characteristics from the baseline survey. We randomly assigned one village per pair to the treatment arm by flipping a coin during a public ceremony.
The implementing partners selected four health clinics to be included in the expansion of the I-PUSH program. Six (6) villages located in the catchment areas of each of these four clinics were randomly selected from a list of all villages in the catchment areas, for a total of 24 villages. The list of villages was provided by the Sub-county government jointly with the i-PUSH program area manager. Random selection was done by the research team using a computer program.
In each village, selected CHVs and PAF’s area manager provided a complete list of households and other necessary information within the work area of each CHV. Based on household demographics and pregnancy information, eligible households were identified. Eligible households included those with at least one woman of reproductive age (WRA) (18-49) who: a) had at least one child below 4 years living with her at baseline; or b) was pregnant at baseline. The team randomly selected 10 eligible households per CHV in each village to be included in the study sample. Additional eligible households per CHV were listed to serve as replacement households for refusals and dropouts.
Initially, the study sought a 50-50 allocation between households with a pregnant woman and households with a child under 4 years old. After the household listing exercise, it became clear that there were too few pregnant women in each village to fulfill this criterion. We then decided to include all pregnant women in our sample up to 50 percent, and randomly sample additional households with children under 4 years old until the cluster size (10 households per village) was achieved. The research team did a random selection as follows: all eligible households with children under 4 years old were entered in Excel sheet and receive a randomly assigned number.
We then conducted a baseline survey which collected information on household demographics, socio-economic indicators, food consumption indicators, financial inclusion, participation in community networks, as well as self-assessed health status, health-related knowledge and behavior, health care utilization and health expenditures, maternal health, mental health, intra-household decision-making processes and gender dynamics. We also collected village-level characteristics including demographic information, infrastructure and access to (health) services. After baseline data collection, villages were matched in pairs and one village in each pair was randomly assigned to the treatment group.
The weekly financial and health diaries commenced two weeks after the baseline data collection was completed and will continue for 18 months from the start of the intervention. The financial diaries record all financial transactions such as income, expenditures, loans, savings and gifts, remittances and loans, including those between household members, in the seven days prior to each interview. The health diaries provide a detailed picture of the incidence of illnesses and injuries, as well as preventive and curative health care utilization. Health diaries collect data on all health events that occurred to any of the household members (respondents, their children and other household members) in the seven days prior to each interview. This includes symptoms, whether any health care was sought, which health provider was visited, health services received, out-of-pocket health expenditures, date of onset of the symptoms and date of provider visit(s). Diaries respondents are also invited to participate in a number of incentivized lab-in-the-field experiments to measure women’s empowerment, risk attitudes, and time preferences.
The study will be concluded by an endline survey scheduled after approximately 12 months of program implementation, incorporating the same modules as the baseline survey, as well as a satisfaction module on participation in the i-PUSH program for women in the treatment areas.