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General

Study Overview

Title:

Evaluation of Conditional Cash Transfers (CCTs) for Immunization

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-58f6ee7725fc1

Initial Registration Date:

04/18/2017

Last Update Date:

07/22/2020

Study Status:

Ongoing

Change History for Status

Changed On	Previous Value
11/21/2017	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 11,200 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.

Change History for Abstract

Changed On	Previous Value
05/05/2020	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 11,200 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.
10/30/2017	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.

Registration Citation:

Chandir, S. and Khan, A., 2017. Evaluation of Conditional Cash Transfers (CCTs) for Immunization. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie105

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:

Subhash Chandir

Change History for Name of First PI

Changed On	Previous Value
04/16/2019	Aamir Khan

Affiliation:

Interactive Research and Development (IRD)

Name of Second PI:

Aamir Khan

Change History for Name of Second PI

Changed On	Previous Value
04/16/2019	Subhash Chandir

Affiliation:

Interactive Research and Development (IRD)

Study Sponsor

Name:

Global Innovation Fund (GIF)

Study Sponsor Location:

United Kingdom

Research Partner

Name of Partner Institution:

Abdul Latif Jameel Poverty Action Lab (J-PAL)

Type of Organization:

Research institute/University

Location:

United States

Intervention

Intervention Overview

Intervention:

The study has 12 arms. The 10 treatment arms include low (USD 5/child) and high incentives (USD 15/child) with two different incentive disbursement methods between arms 1-8 and arms 9-10. 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 . Arm 11 will only receive SMS reminders while control arm 12 will neither receive CCT nor SMS. 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 6 days after the due date if the child has not been vaccinated. The direct beneficiaries include: 1) A total of 11,200 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 16 clinics will directly benefit through the program through reduced administrative burden and improved performance.

Change History for Intervention

Changed On	Previous Value
05/05/2020	The study has 12 arms. The 10 treatment arms include low (USD 5/child) and high incentives (USD 15/child) with two different incentive disbursement methods between arms 1-8 and arms 9-10. 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 . Arm 11 will only receive SMS reminders while control arm 12 will neither receive CCT nor SMS. 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 6 days after the due date if the child has not been vaccinated. The direct beneficiaries include: 1) A total of 11,200 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 16 clinics will directly benefit through the program through reduced administrative burden and improved performance.
10/30/2017	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.

Theory of Change:

The intervention will serve to nudge caregivers to bring about positive health-seeking behaviours, thus resulting in them immunizing their children 

Multiple Treatment Arms Evaluated?

Yes

Implementing Agency

Name of Organization:

Interactive Research & Development (IRD)

Type of Organization:

Other

Change History for Type of Organization

Changed On	Previous Value
04/16/2019	NGO (International)

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Change History for Intervention Timeline

Changed On	Previous Value
04/16/2019	No

Start Date:

11/06/2017

Change History for Start Date

Changed On	Previous Value
11/21/2017	01/01/2017

End Date:

Change History for End Date

Changed On	Previous Value
05/05/2020	06/30/2020

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 11,200 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).

Change History for Details of Evaluation Approach

Changed On	Previous Value
05/05/2020	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 11,200 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).
10/30/2017	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.

Change History for Outcomes (Endpoints)

Changed On

Previous Value

05/05/2020

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.

Hypotheses:

We hypothesize that caregivers receiving incentives and SMS reminders are more likely to immunize their children and on time as opposed to caregivers not receiving the incentive or SMS reminders.

Unit of Intervention or Assignment:

Individuals.

Number of Clusters in Sample:

0

Number of Individuals in Sample:

11200

Change History for Number of Individuals in Sample

Changed On	Previous Value
11/19/2018	9600

Size of Treatment, Control, or Comparison Subsamples:

8000 children will receive incentives, 1600 will only receive SMS while another 1600 will be in control arm.

Change History for Size of Treatment, Control, or Comparison Subsamples

Changed On	Previous Value
10/30/2017	6400 children will receive incentives, 1600 will only receive SMS while another 1600 will be in control arm.

Supplementary Files

Analysis Plan:

Other Documents:

Study Arms: Final Incentive Scheme.pdf

Change History for Other Documents

Changed On	Previous Value
10/30/2017	Description: Intervention Arms Filename: 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; data on transfers/lottery outcomes from the mobile server data and logs maintained by the study team.

Change History for Description

Changed On	Previous Value
04/16/2019	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?

Yes

Change History for Data Collection Status

Changed On	Previous Value
07/22/2020	No

Data Previously Used?

No

Data Access:

Restricted -- Access requires a formal approval process

Data Obtained by the Study Researchers?

Data Approval Process:

Eligible children and caregivers were provided with a detailed explanation of the study and content of the informed consent form after which verbal informed consent was obtained. Contact cards were provided to participants containing the contact details of the study team and IRB in case of any queries/complaints. The child was enrolled in the immunization registry platform and basic biodata, demographic indicators and immunization status of the child along with study arm was recorded

Approval Status:

Yes-obtained approval and have received the data

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:

Yes

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Non-Prospective, Category 4: Data for measuring impacts have been obtained/collected by the research team and analysis for this evaluation has started

Change History for Registration Category

Changed On	Previous Value
07/22/2020	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: