Previous research suggested that cash incentives could be an extremely cost-effective way to increase vaccination rates in areas where childhood vaccination rates are low. However, a randomized evaluation had not been conducted on this model in northern Nigeria. Therefore, before scaling up, New Incentives wanted this model rigorously tested with a randomized controlled trial.
Location
Katsina, Zamfara, and Jigawa States
Timeline
July 2017 - February 2020
Sample
167 Clinics
Research by
IDinsight and Hanovia Ltd.
Funder
GiveWell
167 clinics that met New Incentives’ operational requirements were randomly allocated to either receive the program or serve as a control group during the study period. The program began in 2017 and was fully operational by July 2018.
The research team collected data from caregivers of 5,173 children aged 12 to 16 months. To measure vaccination rates, the research team used caregivers’ reports of their child’s vaccination status (self-reported data) and cross-checked these reports against health cards with immunization records (e.g., child health cards, campaign cards) and immunization registers at the clinics.
An independent randomized controlled trial found that New Incentives' program led to
Increase in full vaccination coverage1
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Increase in timely measles 1 vaccination2
Increase in clinics avoiding stockouts3
Increase in caregivers knowing how many vaccines a child should receive by 1 year4
1Relative to 25% full vaccination coverage rate in the control group.
2Relative to 53% of timely vaccination in the control group.
3Relative to 10% of clinics reporting no stockouts in the control group.
4Relative to 11% of caregivers in the control group.
The randomized controlled trial found that the program more than doubled the percentage of infants 12-16 months old who were fully immunized (BCG, Penta 1-3, and MCV), increasing coverage from roughly a quarter to just over half of all infants. The program generated this impact on top of increases in vaccination coverage that occurred in both control and treatment areas, demonstrating that the program complemented existing efforts.
The study also found that the program improved the timeliness (within 1 month) of receiving the measles vaccine. Receiving vaccinations on time is important, as it maximizes protection against disease.
The portion of government clinics reporting no stockouts went from 10% to over a quarter. This effect is likely a result of program staff checking the quality and stock of vaccines on routine immunization days and encouraging clinic staff to procure more vaccines when vaccine stock was low. “This finding suggests that the program’s impact goes beyond strengthening the demand for vaccines and includes the reduction of supply-side constraints,” according to the independent research firm, IDinsight.
Caregivers in the areas where the program operates also had better knowledge of and more favorable attitudes toward immunization compared to their counterparts in control areas. Caregivers in the treatment areas had higher knowledge of where to get vaccines for their child, at what age their child should receive the first injectable vaccine, and the number of vaccines a child should receive by age 1. The program also had some modest effects on caregivers’ attitudes toward vaccines. These findings provide promising signs that New Incentives’ program can help increase demand for routine immunization in the long term, though future research will be needed to confirm this.
Based on the results of the RCT and other cost analyses, New Incentives has been a GiveWell top charity since 2020.
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