Evaluation of Conditional Cash Transfers (CCTs) for Immunization

Summary

Like many developing countries, Pakistan faces a public health challenge of low and incomplete immunization rates of children, only 54% of children aged 12 to 24 months are fully immunized, which leaves children susceptible to vaccine-preventable diseases. The Expanded Program on Immunization (EPI) is a low-cost and effective health intervention, but the uptake is low, delayed, and completion rates are poor.

Door-to-door campaigns can increase coverage, but are extremely expensive. Incentive-based approaches have been rigorously demonstrated to effectively increase take-up and completion rates of immunization, and there is substantial evidence that small incentives can have a large impact on the take up of preventative health behavior in general. There are two major constraints to scaling these findings, however.

This study will attempt to find the most effective incentive design that helps increase the coverage of full immunization rates among children between the ages of 0 - 24 months in the city of Karachi, Pakistan. The study proposes 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 and mobile top - ups . 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.

Conditions

• Immunization; Infection

Interventions

OTHER

Conditional Cash Transfer

Conditional cash transfer provided via mobile airtime and easypaisa along with SMS reminders to increase immunization coverage and timeliness

OTHER

SMS Reminder

Three SMS reminders for immunization provided before, at and after the due date respectively

Sponsors & Collaborators

• Abdul Latif Jameel Poverty Action Lab

  collaborator OTHER

• Global Innovation Fund

  collaborator OTHER

• Interactive Research and Development

  lead OTHER

Principal Investigators

• Aamir Khan · Interactive Research and Development (IRD)

• Subhash Chandir · Interactive Research and Development (IRD)

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Max Age

23 Months

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2017-11-06

Primary Completion

2020-04-04

Completion

2020-04-04

Countries

• Pakistan

Study Locations