Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives
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Banerjee-2010-Improving immunisati.pdf
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Author(s)
Banerjee, Abhijit
Duflo, Esther
Glennerster, Rachel
Kothari, Dhruva
Date Issued
May 2010
Journal
British Medical Journal
Publisher
BMJ Publishing Group, Ltd.
Citation
Banerjee, Abhijit Vinayak et al. “Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives.” BMJ 340.may17_1 (2010): c2220.
Version
Final published version
Abstract
Objective To assess the efficacy of modest non-financial
incentives on immunisation rates in children aged 1-3 and
to compare it with the effect of only improving the
reliability of the supply of services.
Design Clustered randomised controlled study.
Setting Rural Rajasthan, India.
Participants 1640 children aged 1-3 at end point.
Interventions 134 villages were randomised to one of
three groups: a once monthly reliable immunisation camp
(intervention A; 379 children from 30 villages); a once
monthly reliable immunisation camp with small
incentives (raw lentils and metal plates for completed
immunisation; intervention B; 382 children from 30
villages), or control (no intervention, 860 children in 74
villages). Surveys were undertaken in randomly selected
households at baseline and about 18 months after the
interventions started (end point). Main outcome measures Proportion of children aged 1-3
at the end point who were partially or fully immunised.
Results Among children aged 1-3 in the end point survey,
rates of full immunisation were 39% (148/382, 95%
confidence interval 30% to 47%) for intervention B
villages (reliable immunisation with incentives), 18%
(68/379, 11% to 23%) for intervention A villages (reliable
immunisation without incentives), and 6% (50/860, 3%
to 9%) for control villages. The relative risk of complete
immunisation for intervention B versus control was 6.7
(4.5 to 8.8) and for intervention B versus intervention A
was 2.2 (1.5 to 2.8). Children in areas neighbouring
intervention B villages were also more likely to be fully
immunised than those from areas neighbouring
intervention A villages (1.9, 1.1 to 2.8). The average cost
per immunisation was $28 (1102 rupees, about £16 or
€19) in intervention A and $56 (2202 rupees) in
intervention B. Conclusions Improving reliability of services improves
immunisation rates, but the effect remains modest. Small
incentives have large positive impacts on the uptake of
immunisation services in resource poor areas and are
more cost effective than purely improving supply.
Trial registration IRSCTN87759937.
MIT Department
Massachusetts Institute of Technology. Department of Economics
Abdul Latif Jameel Poverty Action Lab (Massachusetts Institute of Technology)
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DOI of Published Version
https://doi.org/10.1136/bmj.c2220
