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

Last registered on July 03, 2020

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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

Last updated

July 03, 2020 3:46 AM EDT

Location(s)

Country

Nigeria

Region

Africa

Primary Investigator

Name

Pedro Rosa Dias

Affiliation

University of Sussex - Department of Economics

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Marcus Holmlund

PI Affiliation

The World Bank - Development Impact Evaluation

Contact Investigator

PI Name

Marcos Hernández

PI Affiliation

University College London - Economics Department

Contact Investigator

Additional Trial Information

Status

Completed

Start date

2013-09-09

End date

2016-08-06

Keywords

Health

Additional Keywords

Incentives, healthcare workers, maternal healthcare, child health

JEL code(s)

I130, J330

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 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.

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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

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.

Supporting Documents and Materials

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