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Study Overview

Title:
Impact evaluation of the USAID/MIKOLO COSAN Savings and Loan Funds (CSLF) for health intervention in Madagascar
Study is 3ie funded:
No
Study ID:
RIDIE-STUDY-ID-55797a76de9b7
Initial Registration Date:
06/11/2015
Last Update Date:
06/08/2015
Study Status:
Completed
Location(s):
Madagascar
Abstract:
This study is an independent impact evaluation conducted by FHI 360 of a microfinance intervention for community health workers (CHWs) that is being implemented under the USAID/MIKOLO project in Madagascar. MIKOLO is a five year project funded by USAID that aims to increase community-based primary health care service uptake and the adoption of healthy behaviors in the areas of reproductive health, family planning, malaria prevention, and maternal, newborn, and child health. The intervention consists of forming savings and loan groups, called CSLF, among volunteer CHWs. Thirty-two communes will be randomly assigned to intervention or control group; CSLFs will be offered to CHWs in the intervention communes on an opt-in basis. A survey with roughly 900 CHWs and a commune questionnaire with key informants will be administered at baseline, and repeated one and two years later. Focus group discussions and in-depth interviews will be conducted with a subset of CHWs participating in CSLFs at midline and endline. The study will estimate the impact of CSLFs on CHWs’ capacity to save money, selected psychosocial and performance aspects of CHW work, and investments in community health.
Registration Citation:
Categories:
Finance
Health, Nutrition, and Population
Other
Additional Keywords:
Community health workers, Savings and Loan Funds, Community Health, micro finance,
Secondary ID Number(s):
740024-1 FHI 360

Principal Investigator(s)

Name of First PI:
Aurélie Brunie
Affiliation:
Scientist at FHI 360
Name of Second PI:
Affiliation:

Study Sponsor

Name:
USAID Madagascar
Study Sponsor Location:
Madagascar

Research Partner

Name of Partner Institution:
Type of Organization:
Location:
Intervention

Intervention Overview

Intervention:
The intervention consists of the establishment of CSLFs among volunteer CHWs on an opt-in basis. Groups of 15-25 CHWs will receive training and mentoring from a trained technician from a local NGO implementing partner. Member CHWs will meet regularly to make savings deposits of any size; they will be able to take loans from the pooled savings, repaying them with interest. CSLFs will operate in cycles, at the end of which the accumulated savings, interest paid on loans, and earnings from any income-generating activity the group may have undertaken collectively will be shared out among members in proportion to their respective deposits. The CSLF is intended as a source of financing to support CHWs’ activities and health investments for the community. They can increase savings and access to credit, which is expected to facilitate CHW work directly by improving their capacity to finance health commodities, and/or indirectly by reducing constraints related to their economic conditions. Financial opportunities under the CSLF scheme may also facilitate initiatives for community health through profit from income-generating activities or partnerships with microfinance institutions.
Private Intervention Details:
Theory of Change:
Multiple Treatment Arms Evaluated?
No

Implementing Agency

Name of Organization:
Management Science for Health Madagascar, Catholic Relief Services, Overseas Strategic Consulting, Action Socio-Sanitaire Organisation Secours, Institut Technologique de l’Education et du Management
Type of Organization:
NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:
USAID Madagascar
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Intervention Timing

Intervention or Program Started at time of Registration?
No
Start Date:
07/01/2015
End Date:
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Other (specify)
Other (not Listed) Method:
Cluster Randomized Controlled Trail
Additional Evaluation Method (If Any):
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:
Thirty-two rural communes will be randomly assigned to intervention or control group; the intervention (CSLF) will be offered to CHWs in the intervention communes on an opt-in basis. The evaluation will estimate the average effect of the intervention on all CHWs, regardless of whether, when, and how long they may have joined CSLFs (intent-to-treat approach).The study will use mixed-methods. A survey with roughly 900 CHWs and a commune questionnaire with key informants will be administered at baseline, and repeated one and two years later. Focus group discussions and in-depth interviews will be conducted with a subset of CHWs participating in CSLFs at midline and endline. The evaluation will 1) test whether the intervention improves capacity to save money among CHWs; 2) assess whether the intervention provides additional benefits for CHW work, including in particular psycho-social and performance benefits and a reduction of stock-outs of health products (e.g. family planning, medicines) due to financial gaps among CHWs, 3) examine whether the intervention promotes investments in community health, and 4) describe characteristics, processes, and uses of commune-level savings groups.
Private Details of Evaluation Approach:
Outcomes (Endpoints):
The primary outcome is CHWs’ total savings amount. Other outcomes include CHW’s perception of their social status within their community, job satisfaction, and attendance to review meetings, submission of reports, retention, and stock-outs due to financial gaps. We will also examine total expenditures on community health projects.
Unit of Analysis:
The volunteer community health worker (CHW) will be the unit of analysis, although some results will be documented at the commune/CSLF level.
Hypotheses:
Unit of Intervention or Assignment:
Communes (equivalent to a county in the U.S.) will be the unit of randomization.
Number of Clusters in Sample:
32 communes.
Number of Individuals in Sample:
900 CHWs in the CHW survey. Groups of 5-10 key informants in each 32 communes for the commune survey. Six focus group discussions with 9-12 CHWs each and 30 in-depth interviews with a subset of CHWs.
Size of Treatment, Control, or Comparison Subsamples:
The intervention will be offered in 16 communes; there will be 16 communes in the control group.

Supplementary Files

Analysis Plan:
Other Documents:
Data

Outcomes Data

Description:
The CHW survey data will include demographics; perspectives on CHW work, experiences with health products, review meetings and collaboration with other CHWs; household composition, dwelling and assets including land and livestock, other income-generating activities, access to financial tools, and food security and economic shocks.
Data Already Collected?
No
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Treatment Assignment Data

Participation or Assignment Information:
No
Description:
Treatment assignment is known because communes are randomly assigned to treatment by the impact evaluation team. The evaluation will estimate the average effect of the intervention on all CHWs, regardless of whether, when, and how long they may have joined CSLFs (the intent-to-treat approach).
Data Obtained by the Study Researchers?
No
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: