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General

Study Overview

Title:

Mobile Clinics for Social Inclusion in Indonesia

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-662beaf60b9fe

Initial Registration Date:

04/26/2024

Last Update Date:

01/30/2024

Study Status:

Ongoing

Location(s):

Indonesia

Abstract:

In early 2023, the Indonesian NGO Pemberdayaan Perempuan Kepala Keluarga (PEKKA) carried out a series of "mobile clinics" in rural villages in Indonesia. Mobile clinics were organized by local Pekka Unions in conjunction with district and village governments, and provided support to households within the villages in registering for social assistance programs and for legal identity documents. Legal assistance and consultation was also provided. Mobile clinics specifically targeted marginalized households, including female-headed households, households in remote areas, and impoverished households. The mobile clinics were funded by the USAID Rapid Social Response fund, and supported by the World Bank. Villages were selected randomly from a shortlist of eligible villages, allowing for causal estimates of the impacts of mobile clinics on households, villages, and village governments. A midline survey was carried out in late 2023, consisting of a survey of village officials and administrative data collection. The midline study evaluates short-term impacts of mobile clinics on village governments, including the knowledge and attitudes of government officials, village policy and procedures, and village expenditures. Some impacts on social assistance and legal identity were also gathered through legal data. Long-term impacts of social assistance and legal identity on beneficiaries will be evaluated through a longer-term follow-up survey of households. 

Registration Citation:

Categories:

Social Protection
Other

Additional Keywords:

mobile clinics, legal identity

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Forest Jarvis

Affiliation:

World Bank

Name of Second PI:

Affiliation:

Study Sponsor

Name:

USAID

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Pemberdayaan Perempuan Kepala Keluarga (PEKKA)

Type of Organization:

NGO (local) or other civil society organization

Location:

Indonesia

Intervention

Intervention Overview

Intervention:

The mobile clinics, led by the NGO Pemberdayaan Perempuan Kepala Keluarga (PEKKA), consist primarily of one-day events held in 80 villages in 10 districts throughout Indonesia. Cadres from village-level PEKKA unions work closely with village governments, particularly the village head, village secretary, commune chiefs, village social welfare office (Puskesos), and village consultative body (BPD), to organize mobile clinics. PEKKA cadres also work with village governments to notify households in the community of upcoming mobile clinics, specifically targeting vulnerable households and households lacking social protection services or legal identity. During the clinics, representatives from village and district governments set up booths at a central location in villages where they can be consulted by villagers. Services provided during mobile clinics include:

1. Registration for social assistance programs including conditional cash transfers, in-kind food assistance, electricity subsidies, and health insurance
2. Assistance in obtaining legal documents, including birth certificates, death certificates, marriage certificates, divorce certificates, and family cards
3. Legal assistance family law issues such as divorce, child marriage, and domestic violence.

Following the completion of the mobile clinics, village forums are organized where stakeholders in villages including civil society organizations, activists, religious groups, and others can provide feedback on village policy related to mobile clinics. Discussions focus on social assistance, legal identity, and legal rights, and are aimed at helping stakeholders and village government officials better understand roles and responsibilities and the services available for villagers.

Theory of Change:

The midline study focuses on the short-term impacts of mobile clinics on various aspects of village government. In addition to direct assistance to villagers during the clinic itself, clinics involved capacity-building for village governments on areas related to social assistance, legal identity, legal services, and outreach to marginal households. Following the mobile clinics, village forums were held where stakeholders in the village could voice their needs and policy goals in related areas, as well as requests for funding from the Dana Desa (Village Fund) in future years. Impacts on the behavior, knowledge and attitudes are expected to come from a) capacity-building prior to mobile clinic activities; b) increased exposure to marginalized households and social assistance beneficiaries through clinic activities; and c) village forums where village government officials interact directly with marginalized households and stakeholders and discuss village policy. 

Outcomes measured here will be analyzed as potential mechanisms when a long-term follow-up of beneficiaries is carried out. 

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Pemberdayaan Perempuan Kepala Keluarga (PEKKA)

Type of Organization:

NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:

USAID

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

07/04/2022

End Date:

04/28/2023

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:

Mobile clinics were carried out in a treatment group of 80 villages, which were selected through a stratified randomization. The treatment had an overall compliance rate of 93 percent, with 8 treatment villages not receiving mobile clinics and mobile clinics being offered to 3 villages in the control group due to strong demand from village governments. As such, impacts will be evaluated through a POST estimate of the intent-to-treat (ITT) effects, although treatment-on-the-treated (TOT) impacts will also be evaluated, using treatment assignment as an instrument for compliance. Further information on the methodological strategy can be found in the attached pre-analysis plan.

Outcomes (Endpoints):

• Average perceived difficult of registering for social assistance programs
• Average expected time for obtaining legal identity documents
• Average reported administrative and non-administrative costs for obtaining legal identity documents
• Village officials' perceived over/under-coverage of social assistance programs
• Village officials' views of social assistance beneficiaries
• Perceived gender sensitivity of local government
• Gender views of village officials
• Number of households receiving social assistance (measured through administrative data)
• Number of households wth legal identity document (measured through administrative data)
• Funding allocation of village governments

Note that all outcomes here are expected short-term impacts, which will be investigated as mechanisms for a long-term follow-up.

Unit of Analysis:

Village level; outcomes of village officials and village-level statistics

Hypotheses:

• Hypothesis A1: Mobile clinics increase the perceived ease of registering for social assistance and obtaining legal identity

• Hypothesis B1: Mobile clinics affect civil servants’ perceptions of social assistance targeting

• Hypothesis B2: Mobile clinics increase perceived gender-sensitivity of village governments

• Hypothesis B3: Mobile clinics affect village officials’ gender views

• Hypothesis B4: Mobile clinics impact village officials’ perceptions of social assistance beneficiaries

• Hypothesis C1: Mobile clinics increase the number of households receiving social assistance programs

• Hypothesis C2: Mobile clinics increase the number of households receiving identity documents

• Hypothesis D1: Mobile clinics increase the participation of women and women’s groups in village forums

• Hypothesis D2: Mobile clinics increase the allocation of village funds for programs targeting women and female-headed households

• Hypothesis E1: Mobile clinics have different impacts for villages with no PEKKA presence

• Hypothesis E2: Mobile clinics have different impacts for villages with no previous mobile clinic activities

Unit of Intervention or Assignment:

Village-level randomization

Number of Clusters in Sample:

160 villages

Number of Individuals in Sample:

945 individuals (village government officials)

Size of Treatment, Control, or Comparison Subsamples:

80 treatment and 80 control villages; 93% compliance

Supplementary Files

Other Documents:

Data

Outcomes Data

Description:

Two midline surveys were carried out. The first was a survey of village government officials in treatment and control villages, with a total sample of 945 respondents. The second was a village-level administrative data survey, consisting of a review of administrative documents held by village governments that could be disclosed to enumerators.

Data Already Collected?

Yes

Data Previously Used?

No

Data Access:

Not restricted - access with no requirements or minimal requirements (e.g. web registration)

Data Obtained by the Study Researchers?

Yes

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:

No

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 3: Data for measuring impacts have been obtained/collected by the research team but analysis for this evaluation has not started

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: