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Completed

NCT Number: NCT03561012

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

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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Key information

Conditions

Healthy

Age range

15 year–65 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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

Exclusion criteria

-

Treatment and study plan

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).

Control condition

Other

Standard of care

Primary outcomes

  1. At least 2 antenatal home visits in final trimester

    Time frame: Up to 2.5 years

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

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

    Time frame: 2.5 year follow-up

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

  3. At least one home visit within 1 week of delivery

    Time frame: 2.5 year follow-up

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

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

    Time frame: 2.5 year follow-up

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

  5. Postpartum family planning home visits

    Time frame: 2.5 year follow-up

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

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

    Time frame: 2.5 year follow-up

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

  7. Received 90 IFA tablets

    Time frame: 2.5 year follow-up

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

  8. Immediate breastfeeding (within 1 hour of delivery)

    Time frame: 2.5 year follow-up

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

  9. Nothing applied to the cord after cutting

    Time frame: 2.5 year follow-up

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

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

    Time frame: 2.5 year follow-up

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

  11. Current use of any modern method of contraception:

    Time frame: 2.5 year follow-up

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

  12. Child age 6-11 months old received DPT3 vaccination

    Time frame: 2.5 year follow-up

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

Sponsors and collaborators

Lead sponsor

Stanford University

Other

Collaborators

  • Bill and Melinda Gates Foundation

Registry information

Official study title

Use of Team-Based Goals and Incentives to Improve the Performance of Community-Based Health Workers in Promoting Reproductive, Maternal, Newborn and Child Health and Nutrition Behaviors in Bihar, India: A Cluster Randomized Trial

Important dates

Study start
2012
Primary completion
2014
Study completion
2014
First posted
Jun 19, 2018
Registry last updated
Apr 19, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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