SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria

Last registered on July 03, 2020

Pre-Trial

Trial Information

General Information

Title
SURE-P MCH - an experimental evaluation of midwives retention incentives in Nigeria
RCT ID
AEARCTR-0000617
Initial registration date
February 06, 2015

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
February 06, 2015, 6:08 PM EST

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

Last updated
July 03, 2020, 3:46 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
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

Status
Completed
Start date
2013-09-09
End date
2016-08-06
Secondary IDs
ISRCTN98056858
Abstract
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

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, 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://www.socialscienceregistry.org/trials/617/history/71767
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
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
2013-12-01
Intervention End Date
2015-12-31

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?
Yes

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

Institutional Review Boards (IRBs)

IRB Name
National Health Research Ethics Committee of Nigeria (NHREC)
IRB Approval Date
2013-02-02
IRB Approval Number
NHREC/01/01/2007
IRB Name
University College London Research Ethics Committee
IRB Approval Date
2013-02-13
IRB Approval Number
1827/004
Analysis Plan

Analysis Plan Documents

Pre-Analysis plan: midwives retention incentives in Nigeria

MD5: 219290ad8f158a66ec720420140e7b17

SHA1: 33b776a023369b0297f7f98d0cfa097315874c04

Uploaded At: February 06, 2015

Post-Trial

Post Trial Information

Study Withdrawal

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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