Subsidies, Information, and the Timing of Children's Health Care in Mali

Last registered on October 20, 2020

Pre-Trial

Trial Information

General Information

Title
Subsidies, Information, and the Timing of Children's Health Care in Mali
RCT ID
AEARCTR-0006603
Initial registration date
October 16, 2020

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
October 20, 2020, 7:38 AM EDT

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

Locations

Region

Primary Investigator

Affiliation
Massachusetts Institute of Technology

Other Primary Investigator(s)

Additional Trial Information

Status
Completed
Start date
2012-10-01
End date
2014-12-31
Secondary IDs
Abstract
Sustained progress on child mortality requires better acute care. We study how subsidies and healthworkers providing symptom information affect healthcare over- and underuse, which depend not just on overall demand, but on whether children receive care when actually sick. In an RCT of 1768 children in Mali we collect nine weeks of daily symptom and healthcare data to measure demand conditional on need for care, as defined by WHO standards. Subsidies substantially increase care when it is medically indicated, while overuse remains rare. Healthworker visits have no aggregate effects, but may improve use of the subsidy for the youngest children.
External Link(s)

Registration Citation

Citation
Sautmann, Anja. 2020. "Subsidies, Information, and the Timing of Children's Health Care in Mali." AEA RCT Registry. October 20. https://doi.org/10.1257/rct.6603
Experimental Details

Interventions

Intervention(s)
Intervention 1: a subsidy administered via a personalized card that entitles the child to unlimited free consultations at a partner clinic, and free treatment and medication for any illness due to diarrhea/malnutrition, malaria, vaccine-preventable diseases, and respiratory infection (together causing the vast majority of child deaths outside of neonatal conditions). Families have to cover remaining expenses for example for services that are not part of the standard treatment course for a given diagnosis.
Intervention 2: Biweekly community healthworker (CHW) visits. The CHW tracks a set of simple indicators including symptoms and malnutrition measures, teaches basic health practices, and advises families when to visit a doctor or alternatively what care to provide at home, such as rehydration in mild cases of diarrhea. CHWs are recruited locally and their training follows the C-IMCI (Rosales and Weinhauer (2003)), a set of guidelines for community healthworkers that incorporates the WHO's and UNICEF's “Integrated Management of Childhood Illness” recommendations for when to refer children to formal healthcare.
Intervention Start Date
2013-01-01
Intervention End Date
2014-12-31

Primary Outcomes

Primary Outcomes (end points)
Utilization of formal healthcare, conditional on health status.
Primary Outcomes (explanation)
Constructed from consultation records and daily symptom records, grouped into illness spells and classified using the IMCI as either "care required" or "early for care".

Secondary Outcomes

Secondary Outcomes (end points)
Cost per consultation, cost per child, healthcare visits per child.
Secondary Outcomes (explanation)
Used to verify treatment implementation and unconditional utilization effects.

Experimental Design

Experimental Design
The research design took advantage of the second planned roll-out wave of Action for Health (a program combining subsidies and CHW). Our partner NGO Mali Health conducted a census in their expansion area in mid 2012 to enumerate all families with children under five years of age (or a pregnant mother) who satisfied a proxy-means test designed to select approximately the poorest third of households. Data was collected in two survey rounds in 2012 and 2013 during the rainy season (September-November). All households identified in the census that were found at baseline were included in the random assignment to the different treatment groups and revisited in 2013. Mali Health identified 1804 eligible children in the census. At baseline, 1732 children were included in the study. The roll-out of AfH started three months after the baseline in early 2013.
The unit of randomization is the compound. A compound may house more than one household, and typically consists of a few rooms around a common courtyard with shared latrines and other facilities. After stratifying compounds by average household assets, number of eligible children, and location, each was assigned to the subsidy-only group, the CHW-only group, the full treatment group, or the control. The healthworkers in the two CHW treatment groups were trained and managed separately, to avoid spillovers.
Experimental Design Details
Randomization Method
Stratified randomization in office by a computer (Stata)
Randomization Unit
Compound (group of households sharing living space).
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
700
Sample size: planned number of observations
2000
Sample size (or number of clusters) by treatment arms
about 160 compounds per treatment group (CHW, subsidy, full program, control).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
n/a
IRB

Institutional Review Boards (IRBs)

IRB Name
Comité National d’Ethique pour la Santé et les Sciences de la Vie
IRB Approval Date
Details not available
IRB Approval Number
13/MSHP-SG/CNESS
IRB Name
Brown University IRB
IRB Approval Date
Details not available
IRB Approval Number
Comité National d’Ethique pour la Santé et les Sciences de la Vie

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
December 31, 2014, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
December 31, 2013, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
642
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
1768
Final Sample Size (or Number of Clusters) by Treatment Arms
456 control, 430 CHW, 439 subsidy, 443 both.
Data Publication

Data Publication

Is public data available?
Yes

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials