Exciting changes are afoot at New Incentives. After extensive analysis, we are introducing additions to our program, including a vaccination completion incentive for caregivers, incentives for clinic staff, and malnutrition monitoring. We are also exploring other interventions that support child survival. This post outlines the why and what of these additions to our program and what’s next. ‍

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Broadening Our Program Offerings to Increase Our Impact in Nigeria

For now, we are continuing to focus our efforts in Nigeria, as we believe we can continue to make a bigger impact there. Nigeria is the most populous country in Africa, with the highest number of zero-dose children in the world—2.1 million children who, based on 2023 WHO and UNICEF data, hadn’t received a single dose of diphtheria-, tetanus-, and pertussis-containing vaccines. As of 2022, Nigeria also had a mortality rate of 107 per 1,000 live births for children under the age of five (the second-highest under-five mortality rate in the world), and it is estimated that at least 41 percent of deaths among children under five in Nigeria may be vaccine-preventable. Nigeria is unique in that a confluence of factors makes it a cost-effective context to work in, notably its population density, low vaccination rates, and high under-five mortality rates.

Unlike some countries or locations with this level of need, it is also operationally possible to work in Nigeria due to factors like security, political environment, and healthcare infrastructure.

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The Additions: More Incentives and Introducing Other Child Health Interventions

How can we make a bigger impact in Nigeria? To answer this question, we consulted the literature and carried out surveys with key stakeholders. In an upcoming post, we will delve into how gathering feedback from caregivers, field officers, clinic staff, and government and religious leaders plays a key role in guiding our decisions and has made our program stronger. 

This exercise led us to explore and implement program additions that fall into two general categories: more and different incentives for childhood immunizations and additional interventions to improve child health that center around the six incentivized routine immunization visits where New Incentives already has contact with caregivers.

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More and Different Incentives

Since our program’s inception, New Incentives has received repeated suggestions from partners, staff members, and caregivers to incorporate program components that will attract greater spousal participation and more widespread support, motivate clinic staff to help reduce clinic staff absenteeism and stockouts, and further encourage full routine immunization completion.

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Completion Incentive for Caregivers

In July, we changed the incentive structure of our program, adding a bonus of ₦5,000 that is given to caregivers after their child completes their childhood immunizations. The maximum incentive amount caregivers can now receive per child is ₦11,000 (previously ₦6,000). We believe that this addition will increase enrollment rates as well as retention through the immunization cycle. Based on findings from a stakeholder survey, we expect some of the money will be shared with family members, which may increase buy-in from husbands and other family members to participate in routine immunization services. Some women said they would use the additional funds for their businesses.

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Incentives for Clinic Staff

The second direct program addition is cellphone airtime for clinic staff. Two staff per clinic will be eligible for ₦2,000 each month, dependent upon attendance and proper data submission. The clinic staff member performing the malnutrition assessment (more below) will be eligible for an additional ₦2,000 per month. The goal of this addition is to incentivize clinic staff to boost attendance at immunization sessions, improve data integrity, and enhance overall performance. This is currently being piloted and will soon be rolled out across all clinics where we operate.

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Additional Interventions to Improve Child Survival Rates

Low vaccination rates are considered a key contributor to high child mortality rates in northern Nigeria, but they are not the only factor. Other common causes of child mortality include diarrhea from food and water-borne illnesses, as well as malnutrition. Relatively low-cost, evidence-based prevention strategies exist for addressing these issues, but they are not always available to the caregivers who visit the clinics. Layering evidence-based interventions on top of our existing structure could help improve child survival without large increases in staffing or administrative costs. To this end, we have started to explore and pilot the following program additions. 

Layering evidence-based interventions on top of our existing structure could help improve child survival without large increases in staffing or administrative costs.

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Malnutrition Monitoring 

Mid-upper arm circumference, often shortened to MUAC, is a quick and easy way to assess if a child is acutely malnourished. Clinic staff will conduct MUAC measurements at a child’s last two routine immunization visits. New Incentives is currently working with state health officials to develop clinic staff training on taking the measurements and on best feeding practices. New Incentives staff will work with clinic staff to encourage referrals to treatment when needed and reiterate best feeding practices and referral follow-through with caregivers. We anticipate this program addition to be rolled out later this year. 

As we maximize the potential of our program to decrease childhood mortality and morbidity, we will continue investigating and refining ways to support the health system in Nigeria. In the coming months, we will gather quantitative and qualitative data to inform the roll-out of these interventions and will share more as plans develop. Stay tuned for more updates!

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