Primary Care Provider Supply and Patient Outcomes

NCT03131193 | Completed

• 1 other identifier: R01HD083444
• Study Type: interventional
• Target: 10,852
• Locations: 1 country
• Sites: 1

Brief Summary

The evidence on how primary care provider supply and skill relates to patient outcomes is limited and inconclusive. The issue of skill is a particularly important one in low-income countries where the shortage of skilled medical professionals has led to greater use of the task-shifting model in which medical tasks are redistributed from highly skilled health workers to mid-level providers who receive less training. In this large-scale cluster-randomized trial, the investigators randomly select primary health care facilities to receive a highly skilled provider (a doctor), a mid-level health provider, or no additional providers (the control group). The investigators study the effect of this intervention on patient outcomes. Embedded within this trial is another experimental intervention in which pregnant women residing in communities served by the primary health care facilities are assigned to receive a cash transfer conditional on using antenatal, delivery and postnatal care. The investigators study the effect of the cash transfer on health care utilization and on maternal and infant outcomes.

Conditions

Health Services Accessibility; Health Behavior; Health Care Quality, Access, and Evaluation

Outcome Measures

Primary Outcomes (2)

• Clinic attendance

  Utilization of health services will be measured using a questionnaire

  6-12 months after enrollment

• Self-reported health

  Self-reported health status will be measured using a questionnaire

  6-12 months after enrollment

Secondary Outcomes (4)

• Mortality

  6-12 months after enrollment

• Quality of care

  6-12 months after enrollment

• Child weight

  12 months after enrollment

• Child height

  12 months after enrollment

Study Arms (6)

No provider - No cash transfer

NO INTERVENTION

Study primary health centers (PHC) will carry out business-as-usual, with no additional staffing or changes to usual clinic operations. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

No Provider - Cash Transfer

EXPERIMENTAL

Study primary health centers (PHC) will carry out business-as-usual, with no additional staffing or changes to usual clinic operations. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Behavioral: Conditional Cash Transfer

Physician - No Cash Transfer

EXPERIMENTAL

Study PHCs will receive an additional health provider - a physician. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

Other: Physician

Physician - Cash Transfer

EXPERIMENTAL

Study PHCs will receive an additional health provider - a physician. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Other: Physician; Behavioral: Conditional Cash Transfer

Mid-level Provider - No Cash Transfer

EXPERIMENTAL

Study PHCs will receive an additional health provider - a mid-level provider. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

Other: Mid-level provider

Mid-level Provider - Cash Transfer

EXPERIMENTAL

Study PHCs will receive an additional health provider - a mid-level provider. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Other: Mid-level provider; Behavioral: Conditional Cash Transfer

Interventions

Physician OTHER

Study primary health centers will be staffed with an additional physician

Physician - Cash Transfer; Physician - No Cash Transfer

Mid-level provider OTHER

Study primary health centers will be staffed with an additional mid-level provider

Mid-level Provider - Cash Transfer; Mid-level Provider - No Cash Transfer

Conditional Cash Transfer BEHAVIORAL

Study participants (who are pregnant women) will receive a cash transfer conditional upon: registering for and attending antenatal care in the study clinic, giving birth in the study clinic and completing a postnatal visit with the new infant

Mid-level Provider - Cash Transfer; No Provider - Cash Transfer; Physician - Cash Transfer

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Resident in a community served by the study PHC

You may not qualify if:

• Resident in a community served by the study PHC
• Must be in 1st or 2nd trimester of pregnancy
• 3rd trimester of pregnancy

Sponsors & Collaborators

• RAND: lead

Study Sites (1)

Aminu Kano Teaching Hospital

Kano, Nigeria

Location

Related Publications (3)

• Okeke EN, Wagner Z, Abubakar IS. Maternal Cash Transfers Led To Increases In Facility Deliveries And Improved Quality Of Delivery Care In Nigeria. Health Aff (Millwood). 2020 Jun;39(6):1051-1059. doi: 10.1377/hlthaff.2019.00893.

  PMID: 32479220 BACKGROUND

• Okeke EN, Abubakar IS. Healthcare at the Beginning of Life and Child Survival: Evidence from a Cash Transfer Experiment in Nigeria. J Dev Econ. 2020 Mar;143:102426. doi: 10.1016/j.jdeveco.2019.102426. Epub 2019 Nov 22.

  PMID: 32863533 BACKGROUND

• Okeke EN. Money and my mind: Maternal cash transfers and mental health. Health Econ. 2021 Nov;30(11):2879-2904. doi: 10.1002/hec.4398. Epub 2021 Aug 30.

  PMID: 34462990 BACKGROUND

MeSH Terms

Conditions

Health Behavior

Interventions

Physicians

Condition Hierarchy (Ancestors)

Behavior

Intervention Hierarchy (Ancestors)

Health Personnel; Health Care Facilities Workforce and Services

Study Officials

• Edward N Okeke, MD, PhD

  RAND

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Policy Researcher

Study Record Dates

• First Submitted: March 10, 2017
• First Posted: April 27, 2017
• Study Start: March 20, 2017
• Primary Completion: December 30, 2018
• Study Completion: June 30, 2022
• Last Updated: October 21, 2022

Record last verified: 2022-10

Locations

NG (1)