Improving Maternal and Child Health in India: Evaluating Demand and Supply Side Strategies (IMATCHINE)

Duke University

Status: Completed

Conditions: Post-partum Hemorrhage; Obstetric Labor Complications; Pre-eclampsia; Neonatal Mortality; Sepsis

Treatments: Other: Experimental: Treatment 2; Other: Experimental: Treatment 1

Study type: Interventional

Funder types: Other

Identifiers

NCT01480544

Pro00031046

Details and patient eligibility

About

The study evaluates the impact of a new conditional cash transfer (CCT) program (Thayi Bhagya Yojana) to promote child birth in obstetric facilities in the state of Karnataka, India in order to determine its policy value and to guide efforts to improve maternal and infant health outcomes nationally. In addition, the study includes a large randomized evaluation of performance-based incentive payments to providers to improve quality of medical care provided during delivery and actual health improvement in the providers' patient populations and their catchment areas.

Full description

The evaluation study will first provide new evidence on the effectiveness of demand-side strategies to increase institutional deliveries and improve childbirth outcomes. Second, the study will analyze one of the first implementations of direct rewards to providers for health improvement in a developing country. Third, the study will provide critical new insight into dynamics between demand and supply-side incentives in improving population health outcomes as either complements or substitutes.

The study uses household survey to collect data from mothers on socio-economic, human capital, quality of life variables (including below poverty line [BPL] index components) and as well as information about deliveries, fertility histories, morbidity and mortality (for mothers, infants, and children), birth related complications, health service use and spending. Additionally, provider surveys will collect data on infrastructure, staffing, provider qualifications, provider knowledge and process measures of provider performance.

Enrollment: 14,990 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Households with new mothers (one to three weeks after childbirth)
• Rural private sector maternity care providers who are listed on the Karnataka government's legitimate provider list.

Exclusion criteria

• Households without children
• Households where mothers gave birth > 3 weeks ago
• Public sector maternity care providers
• Private sector maternity care providers serving in towns with large public providers such as Community Health Centers (CHCs)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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14,990 participants in 4 patient groups

Mothers at endline

No Intervention group

Description:

Data collected on new mothers (up to three weeks after childbirth) in 180 clusters with 100 mothers in each cluster at endline.

Treatment 1

Experimental group

Description:

Data collected on new mothers (up to three weeks after childbirth) and on providers with incentives for clinical improvements in quality of maternity care in the providers' patient populations and the catchment areas served by the providers.

Treatment:

Other: Experimental: Treatment 1

Treatment 2

Experimental group

Description:

Data collected on new mothers (up to three weeks after childbirth) and on providers with incentives for improvement in maternal and infant health outcomes in the providers' patient populations and in the catchment areas served by the providers.

Treatment:

Other: Experimental: Treatment 2

Control

No Intervention group

Description:

Data collected on new mothers (up to three weeks after childbirth) and providers with no incentives