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| Name | Class |
|---|---|
| Bill and Melinda Gates Foundation | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention arm | Experimental |
| |
| Control Arm | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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). |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
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Inclusion Criteria:
Exclusion Criteria:
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| Control Condition | Other | Standard of care |
|
| 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 |