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SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria
Last registered on July 03, 2020


Trial Information
General Information
SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria
Initial registration date
February 06, 2015
Last updated
July 03, 2020 3:46 AM EDT
Primary Investigator
University of Sussex - Department of Economics
Other Primary Investigator(s)
PI Affiliation
The World Bank - Development Impact Evaluation
PI Affiliation
University College London - Economics Department
Additional Trial Information
Start date
End date
Secondary IDs
The retention of qualified health workers is a key challenge in developing countries. This trial evaluates the effect of monetary and non-monetary incentives provided to midwives employed by the Nigerian Subsidy Reinvestment and Empowerment Programme (SURE-P), on their length of service, performance, behaviour and wellbeing. It also investigates the effect of these incentives on maternal and child health and healthcare use. Finally, the trial investigates the behavioural channels through which the provision of incentives affects the outcomes of interest.

External Link(s)
Registration Citation
Hernández, Marcos, Marcus Holmlund and Pedro Rosa Dias. 2020. "SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria." AEA RCT Registry. July 03. https://doi.org/10.1257/rct.617-1.1.
Former Citation
Hernández, Marcos et al. 2020. "SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria." AEA RCT Registry. July 03. http://www.socialscienceregistry.org/trials/617/history/71767.
Sponsors & Partners

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Experimental Details
The objective of this intervention is to reduce attrition amongst midwives by providing them with retention incentives.

All midwives who are part of this intervention are employed by SURE-P in SURE-P Primary Health Centres (PHC). In order to promote retention, midwives that remain at their duty health facility for increments of three months are eligible to receive a package of retention incentives every three months. The incentives are cumulative, i.e. a midwife cannot qualify for the second three months’ incentive if she has not qualified for the first three months’, and so on.

The implementation of SURE-P is divided in two phases. Phase 1 includes the first 500 PHCs to begin implementing the program, while Phase 2 expands this to a further 500 PHCs. The implementation of SURE-P in both Phase 1 and Phase 2 PHCs continues through the end of 2015.

Intervention Start Date
Intervention End Date
Primary Outcomes
Primary Outcomes (end points)
Primary outcomes:

-Whether midwives are still working 9 months after baseline in the same SURE-P PHC where they were working at baseline
-Duration of service since baseline in the same SURE-P PHC where they were working at baseline

Secondary outcomes:
-Maslach Burnout Inventory of Midwives
-Neonatal mortality collected through an extension of the sisterhood method
-Edinburgh maternal depression index
-An index comprising variables related to health care use of pregnant women, mothers and newborns (detailed in pre-analysis plan)
-Midwives’ locus of control, life satisfaction, happiness and trust in institutions and other people
-Midwives' future prospect regarding job and livelihood
-Conflict between midwives and non-incentivised workers; performance of non-incentivised workers.
-Midwives participation in volunteering activities
-Perception of social norms
-Number of midwives available in the health facility
-Midwives feeling of support and appreciation by their employer
Primary Outcomes (explanation)
See pre-analysis plan
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
In order to evaluate the relative effectiveness of the different packages of incentives, midwives are randomly assigned to three treatment groups, each of each receives a different incentives package and one control group. Full details are provided in the pre-analysis plan.
Experimental Design Details
Randomization Method
Computer-based randomisation
Randomization Unit
The unit of randomization is the cluster, which is comprised of SURE-P PHCs that share the same referral hospital. There are four PHCs in each cluster.
Was the treatment clustered?
Experiment Characteristics
Sample size: planned number of clusters
500 SURE-P PHCs, i.e. 125 clusters receive the intervention in Phase 1;

An additional 126 clusters receive the intervention in Phase 2.

A target sample size of 2,500 households was planned at baseline. The response rate to the household questionnaire was of 95% (2,384 households) at baseline.
Sample size: planned number of observations
2570 midwives, assuming the same number of midwives in Phase 1 and 2
Sample size (or number of clusters) by treatment arms
63 clusters in each treatment arm, and 62 cluster in the control arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
To detect an increase in retention rate from 0.6 to 0.7 at 80% power and 5% significance, we will need 125 clusters and a minimum of 9 midwives per cluster under the assumption that the intra-cluster correlation is 0.1.
IRB Name
National Health Research Ethics Committee of Nigeria (NHREC)
IRB Approval Date
IRB Approval Number
IRB Name
University College London Research Ethics Committee
IRB Approval Date
IRB Approval Number
Analysis Plan
Analysis Plan Documents
Pre-Analysis plan: midwives retention incentives in Nigeria

MD5: 219290ad8f158a66ec720420140e7b17

SHA1: 33b776a023369b0297f7f98d0cfa097315874c04

Uploaded At: February 06, 2015

Post Trial Information
Study Withdrawal
Is the intervention completed?
Is data collection complete?
Data Publication
Data Publication
Is public data available?
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)