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Study Overview

Title:
Evaluation of Conditional Cash Transfers (CCTs) for Immunization
Study ID:
RIDIE-STUDY-ID-58f6ee7725fc1
Initial Registration Date:
04/18/2017
Last Update Date:
12/18/2016
Study Status:
In Development
Location(s):
Pakistan
Abstract:
Immunization rates in developing countries are low and while incentive-based approaches have been demonstrated to effectively increase take-up and completion rates of immunization, research and policy attention on the optimal design and delivery of small incentives is sparse. We propose to conduct a randomized control trial involving small conditional cash transfers (mCCTs) to determine the optimal CCT amount (high versus low), schedule (flat versus increasing) and design (lottery versus sure payment) that would lead to the highest increase in immunization rates. Interactive Research and Development’s digital immunization registry will be used to enrol and randomize the study participants and generate CCTs disbursed through a mobile money transfer platform. The three year study will be conducted in Karachi, Pakistan enrolling a sample of 9,600 children, 0-2 years of age. The study aims to provide evidence regarding the most cost-effective way to structure incentives in terms of size, schedule, and design; and address the challenge of delivering small incentives in a way that is inexpensive, logistically simple, and not subject to leakage.
Categories:
Economic Policy
Finance
Health, Nutrition, and Population
Information and Communications Technology
Additional Keywords:
Immunization, Conditional Cash Transfers, Incentives, Digital registry
Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:
Aamir Khan
Affiliation:
Interactive Research and Development (IRD)
Name of Second PI:
Subhash Chandir
Affiliation:
Interactive Research and Development (IRD)

Study Sponsor

Name:
Global Innovation Fund (GIF)
Study Sponsor Location:
United Kingdom
Funding Proposal:

Research Partner

Name of Partner Institution:
Abdul Latif Jameel Poverty Action Lab (J-PAL)
Type of Organization:
Research institute/University
Website:
https://www.povertyactionlab.org/
Location:
United States
Intervention

Intervention Overview

Intervention:
The study has 10 arms. The eight treatment arms include low (USD 5/child) and high incentives (USD 15/child). Additionally, each arm is further subdivided into flat and sharp increase in amount for the six routine immunization visits recommended by EPI. Furthermore, each sub-arm has further subdivision of lottery and non-lottery. The ninth treatment arm is interactive (2-way) SMS reminder. A total of 3 reminders will be sent for each immunization due: on the evening before the due date, on the morning of the due date, and 5 days after the due date if the child has not been vaccinated. Interactive SMS allows parents to ask questions and share concerns about immunizations, and for EPI program/vaccinators to respond promptly and effectively. The control arm will neither receive CCT nor SMS. The direct beneficiaries include: 1) A total of 9,600 children age 0 - 23 months visiting an EPI center or contacted during outreach activities for any one of the routine immunizations will be enrolled into the registry; and 2) A total of 18 Vaccinators working at 14 clinics will directly benefit through the program through reduced administrative burden and improved performance.
Multiple Treatment Arms Evaluated?
Yes

Implementing Agency

Name of Organization:
Interactive Research & Development (IRD)
Type of Organization:
NGO (International)

Intervention Timing

Intervention or Program Started at time of Registration?
No
Start Date:
01/01/2017
End Date:
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:
The study will measure the impact of our intervention on the immunization rate of eligible children (those aged between 0 – 2 years) using an experimental design. The study participants will comprise of 9,600 children under 2 years of age visiting any one of the 16 EPI centers that have been recruited for the project. The experiment will be a randomized controlled trial with a cross-cutting design. It is structured to answer the most critical design questions for cost-effectiveness. The study has a cross-cutting design as follows: one experiment (1) will have the following design elements: (1a) sharply increasing vs slowly increasing payouts; (1b) high incentive vs low incentive; (1c) a simple SMS reminder vs no reminder. A second experiment (2), orthogonal to the first, will test lotteried payouts vs non-lotteried payouts. We will cross-cut (1a), (1b) and (1c) with (2).
Outcomes (Endpoints):
Primary endpoints: Fully Immunized Child (FIC; BCG+Pentavlent1-3+Measles1) coverage in children 12-23 months old. Secondary Prevalent 3 coverage in children 12-23 months old. Prevalent 3 timeliness in children 12-23 months old. Measles 1 coverage in children 12-23 months old. Measles 1 timeliness in children 12-23 months old. Measles 2 coverage in 2 year old children. Measles 2 timeliness in children 2 year old children.
Measurement:
Unit of Analysis:
Age eligible child for immunization.
Hypotheses:
Unit of Intervention or Assignment:
Individuals.
Number of Clusters in Sample:
Number of Individuals in Sample:
9600
Size of Treatment, Control, or Comparison Subsamples:
6400 children will receive incentives, 1600 will only receive SMS while another 1600 will be in control arm.

Supplementary Files

Analysis Plan:
Other Documents:
Intervention Arms: RCT design_mCCTs for Immunization.pdf
Data

Outcomes Data

Description:
Administrative data will be directly gathered by IRD’s registration and monitoring system and will include: immunization data gathered from cards associated with children being immunized; scanned fingerprints of guardians that bring children in for vaccination; and data on transfers/lottery outcomes from the mobile server data.
Data Already Collected?
No
Survey Name:
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Treatment Assignment Data

Participation or Assignment Information:
Yes
Description:
Data Obtained by the Study Researchers?
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected
Completion

Completion Overview

Intervention Completion Date:
Data Collection Completion Date:
Unit of Analysis:
Clusters in Final Sample:
Total Observations in Final Sample:
Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:
Preliminary Report URL:
Summary of Findings:
Paper:
Paper Summary:
Paper Citation:

Data Availability

Data Availability (Primary Data):
Date of Data Availability:
Data URL or Contact:
Access procedure:

Other Materials

Survey:
Survey Instrument Links or Contact:
Program Files:
Program Files Links or Contact:
External Link:
External Link Description:
Description of Changes:

Study Stopped

Date:
Reason: