Team-Based Goals and Incentives for Community-Based Health Workers to Promote Maternal and Child Health in Bihar, India

NCT03561012 | Completed

• 1 other identifier: TBGI
• Study Type: interventional
• Target: 3,581
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study is designed to evaluate the impact of team-based goals and performance-based incentives for community-based health workers on health-promoting behaviors among women related to reproductive, maternal, newborn and child health and nutrition in Bihar, India. The intervention was funded by the Bill and Melinda Gates Foundation (BMGF) and implemented from 2012 to 2014. Health sub-centers in the catchment areas of five blocks (sub-districts) of the district of Bengusarai were randomly assigned to treatment or control arms (38 sub-centers were assigned to each). Data were collected in the Intervention and Control areas from mothers of infants 0-12 months at baseline and at 2.5-year follow-up, to assess the intervention's effects on quality and quantity of FLW home visits, postnatal health behaviors, and among older infants/toddlers, complementary feeding and vaccination. Difference in difference analyses were used to assess outcome effects in this quasi experimental study. The TBGI intervention was implemented in areas where the BMGF-funded Ananya program (official title: Bihar Family Health Initiative) was also being implemented. Thus, the impact is of the \[TBGI intervention + Ananya\] versus \[Ananya alone\]. The Ananya program was developed and implemented via a partnership of BMGF and the Government of Bihar. The ultimate purpose of Ananya was to reduce maternal, newborn, and child mortality; fertility; and child undernutrition in Bihar, India. Ananya involved multi-level interventions designed to build front line health worker (FLW) capacities and reach to communities and households, as well as to strengthen public health facilities and quality of care to improve maternal and neonatal care and health behaviors, and thus survival. It was implemented from 2012 to 2014. Eight focal districts in western and central Bihar received Ananya, while 30 districts did not.

Conditions

Healthy

Keywords

health; nutrition; pregnancy; infant; child

Outcome Measures

Primary Outcomes (12)

• At least 2 antenatal home visits in final trimester

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  Up to 2.5 years

• At least one home visit within 24 hours of delivery, among women who had a home delivery

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• At least one home visit within 1 week of delivery

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Complementary feeding home visit for women with infant 6-11 months old

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Postpartum family planning home visits

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Obtained phone number for delivery (Frontline worker's (FLW) number, number for private vehicle, number for ambulance, any of the above)

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Received 90 IFA tablets

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Immediate breastfeeding (within 1 hour of delivery)

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Nothing applied to the cord after cutting

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Infant age 6-11 months old ate cereal-based meal in previous day

  Assessed via self-report from representative sample of mothers of children aged 6-11 months.

  2.5 year follow-up

• Current use of any modern method of contraception:

  Assessed via self-report from representative sample of mothers of children aged 0-11 months.

  2.5 year follow-up

• Child age 6-11 months old received DPT3 vaccination

  Assessed via self-report from representative sample of mothers of children aged 6-11 months.

  2.5 year follow-up

Study Arms (2)

Intervention arm

EXPERIMENTAL

Behavioral: Team-Based Goals and Incentives

Control Arm

ACTIVE COMPARATOR

Other: Control Condition

Interventions

Team-Based Goals and Incentives BEHAVIORAL

The intervention included 3 main components. 1) The intervention fostered a sense of team collective responsibility and solidarity (TEAM) by emphasizing the value of teamwork and front-line community health workers (FLWs) reciting a pledge at meetings to serve beneficiaries. 2) To establish goals and coverage targets related to maternal and child health outcomes (GOALs), 7 targets were identified related to delivery preparations, newborn care, exclusive breastfeeding, and family planning. 3) Small non-cash incentives were awarded to FLWs each quarter if their team met greater than 70% of the collective subcenter goals; incentives were most common cookware products (e.g., dish, cooking vessel, steamer). Non-cash incentives also included a certificate of recognition for teams that met their targets in all quarters (INCENTIVES). In the areas of the intervention and control arms, the Ananya program was also underway (see Brief Summary of the project).

Intervention arm

Control Condition OTHER

Standard of care

Control Arm

Eligibility Criteria

• Age: 15 Years - 65 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Mothers of infants 0-12 months residing in the catchment area of the subcenters (public health facilities)

Sponsors & Collaborators

• Stanford University: lead
• Bill and Melinda Gates Foundation: collaborator

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Dean for Maternal and Child Health

Study Record Dates

• First Submitted: June 6, 2018
• First Posted: June 19, 2018
• Study Start: January 1, 2012
• Primary Completion: November 30, 2014
• Study Completion: November 30, 2014
• Last Updated: April 19, 2023

Record last verified: 2023-04