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Despite substantial economic progress in Ethiopia, immunisation rates remain low. Only 24 per cent of Ethiopian children aged 12-13 months are fully immunised, with the rates for the lowest three wealth quintiles being below 20 per cent (Electronic Deployment Health Assessment, 2012). While there have been many attempts to involve communities in increasing immunisation rates, most of these interventions have focused either on increasing awareness or interest or have employed direct (often financial) incentives.
The award has been granted to Zerihun Associates and Marie Stopes International, Ethiopia.
To what extent can supportive feedback and non-monetary incentives:
- bring children into the health system for the first round of immunisation?
- keep children in the health system for continued childhood immunisation?
- increase the frequency of home visits by health extension workers (HEWs)?
- increase the self-reported efficacy of HEWs?
The intervention seeks to leverage links between HEWs and the communities they serve to elicit cooperation and collective action. This will be done by providing supportive feedback to HEWs on their own performance using data from the Ethiopia Child Immunization and Information Network. The feedback will be sent via text messaging through the existing open-source software system, FrontlineSMS. The feedback will include actionable steps that can be taken for improving performance. The intervention also aims to improve performance by offering non-monetary incentives in the form of certificates and public recognition at the community level.
This is a randomised evaluation that also has a qualitative research component. Local health posts (HPs) will be used as the unit of clustering and individual households as the unit of randomisation. A total of 90 HPs will be equally and randomly assigned to treatment and control arms. From the catchment area near each HP, 30 households with children less than 13 months of age will be randomly selected. The total sample size is estimated to be 2,760 children. Quantitative data, such as number and timing of home visits and immunisation status of children, will be collected during the baseline surveys. Knowledge among households about immunisation will be tested using a Likert scale. Their intention to immunise will also be measured using quantitative indicators like ranking child health activities in the order of importance to the household. The study team will also carry out stakeholder interviews at both the baseline and endline stage. The intention to vaccinate will be measured through subjective questions presented in the baseline and endline surveys.