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Study Overview

Evaluation of Conditional Cash Transfers (CCTs) for Immunization
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Initial Registration Date:
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Study Status:
In Development
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.
Economic Policy
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
Interactive Research and Development (IRD)
Name of Second PI:
Subhash Chandir
Interactive Research and Development (IRD)

Study Sponsor

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
United States

Intervention Overview

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?

Implementing Agency

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

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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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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.
Unit of Analysis:
Age eligible child for immunization.
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6400 children will receive incentives, 1600 will only receive SMS while another 1600 will be in control arm.

Supplementary Files

Analysis Plan:
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Intervention Arms: RCT design_mCCTs for Immunization.pdf

Outcomes Data

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.
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Treatment Assignment Data

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Data Analysis

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Study Materials

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Registration Category

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

Completion Overview

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Data Availability

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Other Materials

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Study Stopped