Impact Evaluation of Access to Free Low-Cost Health Insurance in Nigeria's Taraba State

NCT07313631 | Active Not Recruiting

• 1 other identifier: NFWP_Taraba_HealthInsurance
• Study Type: interventional
• Target: 4,000
• Locations: 1 country
• Sites: 1

Brief Summary

The objective of this study is to examine the impact of a free health insurance offer on healthcare use, spending, self-reported health, and economic participation of women in Taraba state of Nigeria.

Conditions

Health Behavior; Economic Problems; Health Status; Healthcare Utilization

Keywords

Health insurance; Care-seeking behavior; Healthcare utilization; Nigeria

Outcome Measures

Primary Outcomes (15)

• Respondent has health insurance

  Zero if not no health insurance, 1 if has health insurance.

  6 months, 9 months, 11 months post treatment.

• Has health insurance card

  Zero if respondent has no health insurance card, 1 if they have a health insurance card.

  6 months, 9 months, 11 months post treatment

• Respondent has successfully used health insurance for consultations, diagnoses, medications, or tests.

  Zero if respondent has not successfully used health insurance for consultations, diagnoses, medications, or tests. 1 if the respondent has successfully used health insurance for consultations, diagnoses, medications, or tests.

  6 months, 9 months, 11 months.

• Sought treatment for most recent illness

  Zero if respondent did not seek care for most recent illness. 1 if respondent did seek care for most recent illness

  6 months, 9 months, 11 months.

• Number of health facility visits in last 3 months.

  Reported number of health facility visits outside the home in the last 3 months.

  6 months, 9 months, 11 months.

• Most recent health facility visit was to a public sector facility

  Zero if last care event was in a private facility, 1 if last care seeking event was in a public facility

  6 months, 9 months, 11 months.

• Money for health care is a key barrier

  Zero if "getting money needed for advice or treatment" is not listed as a barrier. 1 if "getting money needed for advice or treatment" listed as a barrier.

  6 months, 9 months, 11 months.

• Most recent birth was in a health facility

  Zero if most recent birth was not in a government or private health facility. 1if most recent birth was in a government or private health facility. Limited to births in last 3 months.

  6 months, 9 months, 11 months.

• Child has received any vaccinations

  Zero if children aged under 12 months has not received any vaccinations. 1 if child has received at least one vaccination.

  6 months, 9 months, 11 months.

• Total cost of most recent healthcare

  Total cost of most recent healthcare visit, winsorized at the 1% and 99% levels.

  6 months, 9 months, 11 months.

• Most recent care episode reflects catastrophic health expenditure

  1 if most recent healthcare visit expenditure represents represents greater than 10% of household consumption

  6 months, 9 months, 11 months.

• Total indebtedness from healthcare or illness-related expenses

  Total amount of money owed for medical expenses, winsorized at the 1% and 99% levels.

  6 months, 9 months, 11 months.

• Respondent is depressed

  Score equal to or greater than 10 on Center for Epidemiologic Studies Depression Scale.

  6 month, 9 month, 11 month.

• Perceived health status

  Response to the following question: Think about your health over the last 3 months, including any long-term illnesses, hospital or clinic visits, or other ailments, how would you rate your health on a scale of 1-10 where 1 is very low health and 10 is very healthy with no ailments?

  6 months, 9 months, 11 months.

• Number of productive days lost to severe illness in the past 3 months

  Reported number of productive days lost to severe illness in the past 3 months

  6 months, 9 months, 11 months

Secondary Outcomes (17)

• Has ever tried to use health insurance

  6 months, 9 months, 11 months post treatment

• Number of antenatal care visits

  6 months, 9 months, 11 months.

• Most recent health facility care event visit was to a secondary/tertiary care facility (hospital)

  6 months, 9 months, 11 months.

• Received lab test as part of antenatal care in most recent pregnancy

  6 months, 9 months, 11 months.

• Child has received OPV

  6 months, 9 months, 11 months.

Study Arms (2)

Treatment (Health insurance offer)

EXPERIMENTAL

Randomly-selected members of selected Women Affinity Groups (WAGs) randomized to the treatment arm receive an offer for a free, 12-month health insurance policy under the Taraba State Health Insurance Agency's Basic Minimum Package of Health Services (BMPHS), covering essential primary and secondary care (including consultations, preventive services, maternal and child health, emergency care, mental health, and laboratory services).

Other: No-Cost Health Insurance

Control (No insurance offer)

NO INTERVENTION

Members of WAGs randomized to the control arm do not receive the insurance coverage offer during the study period and continued with usual access to care without project-provided coverage.

Interventions

No-Cost Health Insurance OTHER

Provision of a free, 12-month insurance policy from the Taraba State Health Insurance Agency that covers the Basic Minimum Package of Health Services (BMPHS), including outpatient and inpatient consultations, preventive and reproductive health services, maternal and child health care, mental health care, emergency services, and laboratory testing.

Treatment (Health insurance offer)

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Members of one of 1,000 randomly selected women's groups operating in Bali local government area in Taraba State, Nigeria.

You may not qualify if:

• At least 18 years old.

Sponsors & Collaborators

• World Bank: lead
• Harvard School of Public Health (HSPH): collaborator

Study Sites (1)

Bali LGA

Beli, Taraba State, Nigeria

Location

MeSH Terms

Conditions

Health Behavior

Condition Hierarchy (Ancestors)

Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The survey enumerators will not blinded to the treatment status.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Cluster-randomized controlled trial at the Women Affinity Group (WAG) level; 1,000 WAGs randomly assigned (stratified by ward and age strata) into treatment or control (500 each), with four women sampled per group (4,000 total participants).

Study Record Dates

• First Submitted: December 17, 2025
• First Posted: January 2, 2026
• Study Start: October 1, 2023
• Primary Completion (Estimated): August 30, 2027
• Study Completion (Estimated): December 30, 2027
• Last Updated: January 2, 2026

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: We will release data two years after each data collection: Round 1: November 2027 Round 2: February 2028 Round 3: April 2028
• Access Criteria: The data will be publicly available on the World Bank's microdata website. Use of the dataset must be acknowledged using a citation which would include: 1. the identification of the Principal Investigators, 2. the title of the survey (including country, acronym and year of implementation) 3. the survey reference number 4. the source and date of download

Locations

NG (1)