Evaluating the impact of interventions to improve full immunisation rates in Haryana, India

Publication Details

Author
Esther Duflo, Arun Chandrasekhar, Harini Kannan, John Floretta, Mahesh Shrestha and Suresh Dalpath
Country
India
Region
South Asia
Sector
Health Nutrition and Population
Subsector
Health Services, Preventive Health and Health Behavior
Gender analysis
 
Equity Focus
None specified
Evaluation design
Randomised Control Trials (RCT), Mixed Methods
Status
Ongoing 3ie Funded Studies
3ie Funding Window
Innovations in Increasing Immunisation Thematic Window

Synopsis

This impact evaluation has three distinct sets of experiments that will assess interventions for improving full immunisation rates in seven districts in rural Haryana. The interventions aim to build demand for vaccinations through the provision of small incentives, the identification and involvement of trusted members of the community, and regular reminders.

Context

In India, only 54 per cent of children aged 12 to 24 months are fully immunised, according to the District Level Household Survey (DLHS- 3, 2007-2008). In the state of Haryana, DLHS shows that full immunisation rates actually fell from 60 per cent in 2007-2008 to 52 per cent in 2011-2012. Over 268,000 infants and children aged 0-1 years are not on track to be fully immunised (DLHS 4 2011-2012).

Research questions

  1. Will small incentives provided with each vaccination shot in an immunisation camp improve full immunisation rates among children, compared to just conducting camps without providing any incentives?
  2. How do different types of information and communication treatment arms compare with each other and with a control group, in terms of their effectiveness in improving full immunisation rates among children?
  3. Do individuals in a village identified as a ‘trusted source of health advice’ by other villagers spread information on immunisation when it is given to them? Does this lead to greater immunisation rates?
  4. Do child-specific tailored reminders increase child immunisation rates?

Methodology

The study team will evaluate the impact of three distinct sets of experiments for improving full immunisation rates in seven districts in rural Haryana. The interventions aim to build the demand for vaccinations through three innovative experiments.

The first experiment, will be conducted in 140 primary health centres, of which 70 will be randomly chosen to receive the treatment. The treatment consists of providing parents with a small incentive (1 kg of sugar) for each routine immunisation vaccine given to their child and a slightly larger incentive (1 litre of mustard oil) on completing the routine immunisation cycle. The second experiment is a communication experiment that has five treatment arms:

1. Broadcast information: all individuals in the treatment village that have a child aged below three will receive an SMS that provides information about immunisation camps, encouraging them to vaccinate their children.
2. ‘Random’ seed: Among the households with children aged below three, 5-10 will be selected at random. They will be sent regular SMSs to remind them about immunising their children and asking them to spread information about immunisation and related camps in their village.
3. ‘Gossip’ seed:  Five per cent of the households will be randomly chosen and asked to nominate a few households that are best positioned to spread information most widely in the village. Five to ten people who have received high number of nominations will be chosen as ‘gossip’ seeds and asked to spread information about immunisation and related camps.
4. Trusted’ seed: Five per cent of the households will be randomly chosen and asked to nominate a few households that are trusted in the village to give health-related advice. Five to ten members who have received a high number of nominations will be chosen as the ‘trusted’ seeds and asked to spread information about immunisation and related camp sessions.
5. ‘Trusted gossip’ seed: This will be a combination of ‘gossip’ and ‘trusted’ seeds in which five to ten members who have received a high number of nominations and who are also best positioned to spread information and are trusted by the villagers will be chosen and asked to spread information about immunisation and related camps.

The third experiment is a tailored-message experiment that will be conducted in villages assigned to random seed and broadcast interventions. Around 2,400 households with children under nine months or with pregnant women (in their last trimester) will be selected. Half of the households (1,200 households) will be randomly chosen to receive an SMS that would be tailored to the child in the household based on either actual or expected date of birth. The SMS will remind parents of which vaccination shot the child has to take and when and where they can receive it.

Quantitative Analysis:

The study team will conduct a mapping and census exercise at baseline in 980 villages. The baseline survey will capture the immunisation history of children, and perceptions and beliefs about immunisation among parents.

Qualitative Analysis:

During the implementation of the intervention, the study team will conduct unstructured interviews with the National Health Mission staff of the government of the Indian state of Haryana and the beneficiaries to assess if the implementation process is proceeding as designed and to address any operational challenges, if they exist.

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