Financially-Incentives to Improve Provider Compliance

NCT04634019 | Active Not Recruiting

• 1 other identifier: IncentLearn
• Study Type: interventional
• Target: 600
• Locations: 2 countries
• Sites: 2

Brief Summary

The main objective of this study is to assess whether making health financing streams conditional on provider performance on knowledge assessment can increase provider compliance with under-5 case management guidelines.

Conditions

Compliant Behavior; Morbidity;Infant

Keywords

financial incentives; provider behavior; vignettes

Outcome Measures

Primary Outcomes (1)

• Compliance with integrated management of childhood illness (IMCI) guidelines

  Compliance will be measured through up to 8 direct observations of under-5 sick child visits at each facility collected over a four-day period. During each visit, trained observes will document how many of the 10 diagnostic steps specified in the WHO's Integrated Management of Child Illness (IMCI) are followed by the provider. Compliance will be defined as least 8 out of 10 diagnostic processes completed.

  Endline (30 months after project start)

Secondary Outcomes (1)

• Knowledge regarding IMCI guidelines

  Endline (30 months after project start)

Study Arms (2)

Control arm

NO INTERVENTION

Providers in control facilities will not receive any additional training or knowledge assessments.

Financial incentive arm

EXPERIMENTAL

Providers in treatment facilities will be visited once a quarter for a knowledge assessment using vignettes. Facilities performing well in this assessment will receive a quarterly bonus payment, which will be distributed among providers.

Behavioral: Financially incentivized knowledge assessments

Interventions

Financially incentivized knowledge assessments BEHAVIORAL

We will conduct quarterly provider knowledge assessments at selected health facilities and will pay facilities a financial bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members will be informed hat every 3 month there will be a knowledge assessment based on these vignettes and that the results will determine the total bonus payment made to the facility.

Also known as: Provider knowledge assessments

Financial incentive arm

Eligibility Criteria

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

You may qualify if:

• all providers working at the 110 facilities selected for the study will be included in the study.

You may not qualify if:

• none.

Sponsors & Collaborators

• Swiss Tropical & Public Health Institute: lead
• World Bank: collaborator

Study Sites (2)

Congo Ministry of Public Health

Kinshasa, Democratic Republic of the Congo

Location

Swiss Tropical and Public Health Institute

Basel, Canton of Basel-City, 4051, Switzerland

Location

Related Publications (1)

• Fink G, Fritsche G, Samaha H, Sese C, Shapira G. Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial. Trials. 2022 Mar 21;23(1):227. doi: 10.1186/s13063-022-06129-8.

  PMID: 35313932 DERIVED

MeSH Terms

Conditions

Cooperative Behavior

Condition Hierarchy (Ancestors)

Social Behavior; Behavior

Study Officials

• Gil Shapira, PhD

  World Bank

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This will be a two-arm parallel trial - control vs intervention.

Study Record Dates

• First Submitted: November 6, 2020
• First Posted: November 18, 2020
• Study Start: January 1, 2018
• Primary Completion: September 30, 2022
• Study Completion: December 31, 2025
• Last Updated: May 23, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ANALYTIC CODE
• Time Frame: Upon completion of study
• Access Criteria: public access

Locations

CH (1); DE (1)